Dr. Robert Tranbaugh, chief of cardiac surgery at Beth Israel Medical Center, was in high school when the first coronary bypass was performed. Thirty-three years later, Tranbaugh will be part of the latest advance in heart surgery when the da Vinci Surgical System goes into clinical trials at Beth Israel in April. A combination of robotics and advanced computer technology, the da Vinci system allows doctors to perform bypass surgery without cutting open the chest. Seated a few feet from the patient, the surgeon views the procedure in close-up on a console that looks like an oversize microscope. Flexible handles transmit the doctor's hand movements to three robotic arms above the operating table. One holds a micro-camera while the other two employ changeable surgical instruments. These long black rods are inserted into the patient through three small incisions in the chest. "We can open arteries, cut tissue, whatever is needed," Tranbaugh explains. The system is in the protocol phase for cardiac work, and should be approved by the FDA for laparoscopic use in the next two months, though it's already available in Europe (indeed, last October, a German cardiac team used it in the world's first closed-chest, multi-vessel bypass). Da Vinci could potentially be used for vascular surgery, hysterectomies, and hernia repairs.
Surgeons at Lenox Hill Heart and Vascular Institute of New York, meanwhile, led by Dr. Valavanur Subramanian, are approaching closed heart surgery in a different way. Subramanian has developed the transabdominal minimally invasive direct coronary-artery bypass (transab midcab), whose concept is simpler than its name: heart surgery via the belly. Since the heart sits between the chest and the abdomen, doctors can perform multiple grafts by making a small incision through the belly underneath the rib cage and detaching the muscles that enclose the heart. "We don't divide any bones or ligaments," says Dr. Subramanian, adding that "the morbidity rate is extremely low, and patients can return to their functional life in a couple days."