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Robotic Surgery Institute

USC Surgeons Perform Surgical "First" with Robotic Assistance
HSC Weekly, August 10, 2001

Watch the video: Posterior Mediastinal Tumor
MPG file: 2 minutes, 28 seconds

USC surgeons recently became the first in the world to remove a tumor from deep within a patient's chest using the da Vinci surgical robot.

A benign schwannoma was removed from patient Daniel Gutierrez's spine-while a USC cardiothoracic surgeon was seated eight feet away. The July 13 surgery at USC University Hospital was the first procedure ever to remove such a tumor-known as a posterior mediastinal mass-with the da Vinci Surgical System, according to Intuitive Surgical, the maker of the robot.

Posterior mediastinal tumor
Posterior mediastinal tumor

A USC cardiothoracic surgeon used the da Vinci Surgical System to operate on Gutierrez remotely by manipulating hand-held controls and pushing foot pedals, all while watching the patient's organs magnified before him on a three-dimensional video screen at a computer console.

The surgical tools and a slender video camera were mounted onto the three arms of the 1,000-pound da Vinci robot, positioned beside the patient. The instruments' fully rotating tips and the camera were inserted into the patient's torso through small holes in the skin.

USC's da Vinci robot-nicknamed Maximus-perfectly mimicked the surgeon's hand movements, deep within the patient's chest.

Traditional surgery for resecting a posterior mediastinal mass involves a thoracotomy: splitting the chest between the ribs. That means a long incision, and patients usually stay in the hospital from five to seven days. A thoracoscopic procedure, in which surgeons operate using specialized instruments through smaller incisions in the skin while watching their work on a video screen, requires less recovery time.

But with the da Vinci surgical robot, patients can heal even more quickly and experience shorter incisions and less scarring, pain, trauma and blood loss. The robot allows surgeons to perform procedures more precisely than ever before.

That came as good news to Gutierrez, who had developed a tumor about the size of a small orange next to his spine. Such slow-growing, benign tumors, though rare, may be detected through routine chest X-rays.

With da Vinci, a USC cardiothoracic surgeon was able to see the tumor magnified five times its actual size on his video screen and could position the surgical tools exactly where he needed them. He carefully detached the tumor from surrounding tissue by using tiny cauterizing tools. With the help of the surgical team, he then cut the tumor in half-while it was still in the body-and placed it within a bag. Surgeons then pulled it out through a 3.5-centimeter incision between two ribs, without needing to push the ribs apart (saving the patient potential post-operative pain).

Gutierrez was able to leave USC University Hospital only three days after the operation, with the advice that he could likely return to work two weeks later.

The revolutionary surgery drew attention from a variety of physicians and other observers. Vaughn Starnes M.D., Hastings Professor and chair of cardiothoracic surgery at the Keck School, stopped by to watch the team use da Vinci.

A Los Angeles Times medical reporter and photographer also watched the procedure, after seeing a mitral valve repair performed by Dr. Starnes that morning.

Dr. Starnes and his team have already performed three mitral valve repairs using the da Vinci surgical robot. USC is one of several sites in the United States in a Food and Drug Administration-approved trial to evaluate the use of the da Vinci Surgical System to repair the heart's mitral valve.

The robotic surgical system is already used in Europe for numerous procedures, including gynecologic, urologic, abdominal, chest and heart operations.

In the U.S., however, approvals have come more slowly. The FDA has approved the da Vinci system for use in laparoscopic surgical procedures including cholescystecomy (gall bladder surgery) and Nissen fundoplication (treatment for acid reflux or heartburn), as well as for urologic surgeries. Recent approval of its use in thoracoscopic procedures, too, opened the door for surgeries such as the tumor removal at USC University Hospital.

In the future, USC Cardiothoracic Surgery hopes to apply the robot to pulmonary diseases and other common thoracic problems. And Dr. Starnes hopes to lead a national clinical trial evaluating da Vinci's usefulness in performing coronary artery bypass grafts.

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