 Robot assists keyhole
heart surgery at London hospital
Routine use of keyhole surgery in cardiac procedures has come a step
closer with the successful use of robotic equipment to help repair a mitral
valve at St Mary's Hospital in London.
Using an Armstrong EndoAssist camera-holding robot, surgeon Mr Roberto
Casula carried out the first keyhole procedure of this kind through a small
chest incision in June this year, without having to cut through the breast
bone. The robot held the endoscope so as to provide Mr Casula with a
close-up and steady view of the heart valve, moving the camera on his
command.
When keyhole, or minimally invasive procedures were first introduced
about 25 years ago, there was a great deal of interest from cardiothoracic
surgeons. However, technical problems together with a lack of suitable
endoscopic tools meant that early keyhole heart surgery faced real
difficulties. While keyhole techniques have developed in general surgery,
and it has become routine in cholecystectomy (removal of the gall bladder),
it hasn't taken off in cardiac surgery.
Conventional heart surgery is one of the most invasive procedures
performed by surgeons. Open-heart surgery relies on cutting the breastbone
to gain access to the heart and the use of a heart–lung machine to maintain
circulation while the heart is operated on. Although open-heart surgery has
achieved a very high success rate, it involves great trauma and a very high
risk of infection. Recovery is usually prolonged, even if the patient does
not become infected as a result of the operation.
Recent advances in robotic equipment and developments stemming from
keyhole lung surgery have make keyhole heart surgery more practicable.
After performing the operation, Mr Casula said: "Thanks to innovative
technologies, we can now perform cardiac operations through small skin
incisions and most of all without cutting the breast bone. This has a
positive impact on our patients' recovery and in terms of reduced chest pain
and discomfort after surgery. The number of minimal-access operations we can
now perform has increased steadily over the last three years in our hospital
and the aim is to offer cardiac surgery through a small incision to the
majority of our patients in the near future."
Armstrong Healthcare, the company that manufactures the EndoAssist, is
establishing a number of beta-sites in the UK and in Europe for its
PathFinder image-guided neurosurgical robot. The company is applying for
510(k) notification from the US Food and Drugs Administration to sell
PathFinder in America. The product already has CE Mark approval for sale
within the European Union.
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