University Of Pittsburgh Surgeons First In U.S. To Use Zeus Robot During Cardiac Bypass Surgery On A Beating Heart

The 63-year-old male patient underwent multivessel off-pump coronary artery bypass surgery at UPMC Presbyterian Hospital on April 5 as part of a national, multi-center trial seeking to evaluate whether the robotic system can be helpful to surgeons and be safely used for the surgical connection of the left internal mammary artery graft to the left anterior descending artery.

The University of Pittsburgh is one of 12 centers in the research study and the first U.S. center to use the ZEUS in a beating-heart bypass operation. The robot had been used in 32 patients at three centers as part of a phase one trial, but in all of these cases, the operation involved the use of a heart/lung machine while surgeons operated on a stopped heart.

Marco A. Zenati, M.D., assistant professor of surgery and principal investigator at the Pittsburgh site, operated the robot while seated at a console about 10 feet from the patient. One arm of the robot, which responded to his voice commands, positioned the endoscope, an instrument with a tiny camera that magnifies the operative site up to 10 to 15 times. While viewing the magnified image of the heart and vessels on a high-resolution monitor, Dr. Zenati controlled the action of surgical instruments attached to the two other robotic arms by operating handles that resemble conventional surgical instruments, in much the way joysticks are used to control the action of a video game.

"ZEUS is designed to give a surgeon greater precision while performing microsurgical tasks, and to be able to use it during a beating heart operation is quite significant. Essentially, it may allow surgeons to perform superhuman tasks, because the robot overcomes our dexterity and precision limitations," said Dr. Zenati.

The hand movements of the surgeon are scaled. For instance, one inch of movement by the surgeon results in a 1/4 inch movement by the robotic surgical instruments. Hand tremor is filtered by the computer and translated via the robotic arms into precise micro movements at the operative site. According to Computer Motion, Inc., the Santa Barbara-based company that developed ZEUS, the possible benefits of using ZEUS in a closed-chest heart bypass surgery include less patient pain and trauma, quicker recovery times and reduced health care costs. That is because robotics and computers provide enhanced dexterity, steady visualization and improved ergonomics for the surgeon. The reduced trauma to the patient, from a minimal incision and the avoidance of the heart-lung machine, can translate into reduced costs.

"The use of robotics for cardiac surgery is an extremely exciting development for the field. It is anticipated that the future will soon see all cardiac procedures employing such technology, and surgery will become less and less invasive for the patient," said Bartley P. Griffith, M.D., Henry T. Bahnson professor of surgery and chief, division of cardiothoracic surgery at the University of Pittsburgh School of Medicine. Dr. Griffith is a co-investigator of the study and assisted Dr. Zenati during the operation. Dr. Zenati also was assisted by Larry Shears, M.D.