A woman lies anesthetized on the operating table. Bright primary colors dominate the room: the brilliant yellow of iodine-scrubbed skin, the red of blood, the green of surgical scrubs worn by all. Medical students flank a far wall, the Greek chorus of the surgical theater. From a CD player in the corner, the Beatles croon softly, "I wanna hold your haaand."
This looks like any operating room, but this surgery - a heart-valve repair - will be anything but typical. The surgeon, sitting at a console that resembles a virtual-reality game console, will use a robot to operate from across the room.
Doctors hope the robotic Da Vinci Surgical System will make open-heart surgery a lot less open and a lot easier on the heart. Rather than cracking the sternum to allow the surgeon's hands access to the heart, the largest incision doctors make is an opening, 4 centimeters square, between the ribs. Two smaller incisions give the robot's two working arms access to the heart.
A major goal in surgery these days is to be minimally invasive. The least invasive surgeries thus far have been endoscopic, or camera-assisted. In this method, a camera is guided through the body so that surgeons can operate without having to open up the body.
Robotic surgery is designed to improve on endoscopic surgery, which is routinely used for operations such as gall bladder removal. And, for the first time, the robot will make heart surgery possible without a traumatic sternotomy, or cracked chest bone.
Da Vinci has been approved by the Food and Drug Administration for general and thoracic surgeries, allowing hospitals to use it for surgeries involving the liver, esophagus and lungs. The FDA is considering approving it as the equipment for cardiac surgeries.
Doctors say that such approval should mean faster and less painful recoveries for heart-surgery patients who had access to the robotic technology. But the expense of the machine - about $1 million - will likely limit its use to larger medical centers where such surgeries already are routine.
After all, the robot is only an extension of a highly skilled surgeon. Dr. Vaughn Starnes, a University of Southern California professor of surgery, who was among the first surgeons to use Da Vinci for operating on the heart, said the robot's "hands" work like tiny extensions of his own. The hands move in six different ways, giving them distinctly wrist-like movements. The computer senses the position of the surgeon's hands 1,400 times every second. And, unlike human hands, the robot's are not subject to trembling.
