November 16, 2009 - By Sara Wykes
Paul Wang, director of Stanford Hospital’s Cardiac Arrhythmia Service, uses a robotic system for operations. He says it lets procedures be done more quickly and with greater precision and consistency.
Father John Coleman has felt so good after a recent procedure at Stanford Hospital & Clinics to correct his heart’s arrhythmia that he’s played 18 holes of golf, more than once. “I figure if you keep moving, you stay alive,” said Coleman, a sturdy 83-year-old who previously came through total knee and hip replacements, pacemaker surgery and pneumonia.
Coleman’s other surgeries and procedures were very traditional. This last one was not. Amin Al-Ahmad, MD, and Paul Wang, MD, used a robot-driven assisting arm that hovered over Coleman during the operation, performing precision surgery as directed by a joystick held by Al-Ahmad, seated a few feet away.
“My vision is that this technology will allow us to do things we haven’t been able to do previously,” said Wang, director of the Cardiac Arrhythmia Service. “We won’t have to compensate as we do with our hands, and we’ll have a device that works in a 360-degree field.”
The robotic arm and joystick combination was recently added to the hospital’s options for cardiac care. Al-Ahmad, associate director of the arrhythmia service and director of the Cardiac Electrophysiology Laboratory, served as a design consultant for the manufacturer of the new device and has accumulated extensive experimental experience with the device.
The appeal of consistency and fine motor control have made robot arms an appealing new adjunct to a variety of surgical procedures at the hospital, in areas including urology and gynecology.
For Coleman’s procedure, Al-Ahmad threads a special catheter through a blood vessel that leads to his patient’s heart, guiding it delicately within the blood vessel. Once the catheter is inside the heart, precision is important to accomplish what Wang wants: to find the cells responsible for the electrical activity that caused Coleman’s heart to beat irregularly. After zeroing in on the particular cells, Wang zaps them with lethal amounts of radiowaves, enough so the cells are permanently damaged and do not cause Coleman’s problems again.
The robotic arm Wang and Al-Ahmad use is manufactured by Hansen Medical; Wang said he owns stock in the company.
With the robot to help, physicians are able to finish the surgery more quickly. The robot also performs movements the same way every time, which can improve the reliability of the procedure. “It just makes so much sense,” Wang said. “My vision is that this will allow us better success, to do procedures in a much more straightforward way.”
The robot ablation was a good choice for Coleman, because the operation was focused on a specific area. “We knew where to go,” Wang said. “His arrhythmia was anatomically fairly well-defined. We knew where it was going to be.”
The robot also overcomes the element of human fatigue, Wang said. “Standing at the table for hours is very tiring, and that exhaustion can make it difficult to consistently reproduce the required fine movements,” he said. Younger surgeons training with the robot may have an advantage over older colleagues in learning the new approach. “The joystick is very much a modern interface, especially for those younger physicians who have grown up with electronic games,” he said.
Using a robot also means that surgeries can be practiced on a simulator until the movements are familiar and the procedure can be completed more quickly. “The future is for a physician to import a scan of the patient’s heart and to go through the exact steps he or she will use during the procedure,” Wang said. “This will revolutionize how we perform heart rhythm procedures.”
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