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Biomedicine

Heart Hackers

To get their scalpels onto an ailing heart, surgeons usually have to crack open a patient’s rib cage-not a pretty sight, nor a procedure helpful to the healing process. That standard method may change soon: Using experimental robotic surgical instruments, physicians in France and Germany have performed a series of ground-breaking heart operations through dime-sized incisions, without any rib cracking at all. The advances culminated in late June when Alain Carpentier and Didier Loulmet of Broussais Hospital in Paris used the new techniques to perform a coronary artery bypass graft.

Minimally invasive surgery-which leaves patients with tiny scars and little post-operative pain-is already commonplace for procedures such as removing gallbladders. But more complex operations, such as heart surgery, have resisted minimally invasive methods, which generally require physicians to operate using awkward chopstick-like instruments. The French team of physicians was able to push the envelope thanks to a new system that gives joystick-wielding surgeons precise control over dexterous surgical instruments.

To use the system, originally developed at SRI International for battlefield telesurgery and now being commercialized by Intuitive Surgical of Mountain View, Calif., the surgeon sits at a console and peers into a close-up 3-D image of the patient’s heart. The image is captured by a scope inserted between the patient’s ribs through one of three small incisions. The remaining openings are for remote-controlled arms tipped by detachable instruments (choices include scissors, a suturing device and a grip) that swivel on an advanced wrist-like joint.

Intuitive’s Thierry Thaure, vice president for marketing, claims that surgeons find that the system’s robotic hands are even more precise than their own. They’re also steadier: The computer filters out unintended movements by the operator, such as shaking.

Not all heart surgeons are fans of “robosurgery,” however. Although current methods can mean a painful recovery for a patient and a large scar, they are tried-and-true. What’s more, in minimally invasive heart surgery, physicians must divert blood from the heart with a tricky system of catheters that can damage vessels. Thaure admits that getting doctors to try the novel setup may be challenging. They may, however, be persuaded to try it by their heart patients. The French doctors report that 24 hours after surgery their 69-year-old patient felt so good that he refused pain medication.

Intuitive Surgical plans to ask the Food and Drug Administration for permission to sell the minimally-invasive surgery system in the United States next year.

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