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.

"It's an incredible difference than the usual patient who has bypass surgery, who, by and large, if they're active at all at work, have to take off at least nine weeks," Griffith said.

While robotically assisted surgery has become common in other fields, it has not been widely adopted by heart surgeons. One doubter wrote a commentary in a medical journal titled "Robotics in Cardiac Surgery: the Emperor's New Clothes."

"Do we need a robot to do it? Does a robot really improve things?" asked Wini Hayes, the head of Hayes Inc., a firm that analyzes the costs and benefits of new medical technologies.

"It's a big investment for a hospital to put in a robotic device, and it might be wise to slow the pace of dissemination until some of these things are sorted out," she said.

Some doctors said robotic systems are useless for many patients who may have blockages in hard-to-reach places. They said the operation is riskier, and the equipment is expensive: $1.3 million for a single operating room.

Hayes said some hospitals might invest in a robotic system because they can advertise that they have it, not necessarily because they believe it is better.

Poston and Griffith said many of those points are valid. But they argued that patients go home more quickly and return to work sooner -- something welcomed by corporations that face rising costs for medical insurance.

"The upside is that there's less cost after surgery," Poston said.

Roger Suter, Poston's early patient, said he had his operation on a Wednesday and went home four days later, refusing the hospital's offer of a wheelchair.

"I didn't feel bad, I had no pain, it was great," he said.