Scalpel, Sponge, Robot Arm Please

BALTIMORE, May 27, 2008 — -- Roger Suter said he had no idea what was happening to him. Chest pains? He thought he had bronchitis.

He said he was floored -- "pretty bummed" -- when the doctor told him he needed multiple bypass surgery.

Coronary bypass is a common operation in America but a drastic one, too. To reach the heart and replace the blocked blood vessels that supply it, surgeons have to cut open one's breastbone.

But at the University of Maryland Medical Center in Baltimore, doctors have been trying an alternative: a system known as da Vinci. Instead of opening a patient's chest, surgeons make a few small incisions to insert tiny robot arms.

"There's a lot of invasion that goes along with traditional heart surgery," said Dr. Robert Poston, who helped pioneer robotic bypass surgery at Maryland and has recently become chief of cardiac surgery at Boston Medical Center. "If you can avoid all that, and go in between the ribs, not crack any bones, then that is one less thing you have to heal up."

Roger Suter was one of Poston's first patients, a year and a half ago. When Poston offered him the chance to take part in the experiment, Suter said he found the decision easy.

"Sounded as if there was some risk, but the benefits outweighed the risk all the way around," Suter said.

Poston and a Maryland colleague, Dr. Bartley Griffith, said they believe robotics could make a major difference in bypass surgery, but until now, they lacked the data to persuade their colleagues.

At a meeting of the American Surgical Association, they reported that the first hundred patients on whom they operated did very well.

They spent three fewer days, on average, in the hospital. They needed about a third as many blood transfusions.

The less-invasive surgery was of special benefit to high-risk patients -- those who suffered from diabetes, lung disease, obesity or other problems that made them poor candidates for a major operation.

And a year after surgery, 99 percent still had clear arteries, compared with 80 percent of patients who had conventional "open" bypass surgery.