Robotic Ablation Offers New, Minimally Invasive Options for Cardiac Arrhythmia Patients
NOVEMBER 4, 2009
Father John Coleman has felt so good after a recent procedure at Stanford Hospital & Clinics to correct his heart’s arrhythmia that he’s played 18 holes of golf, more than once. “I figure if you keep moving, you stay alive,” said Coleman, a sturdy 83-year-old who previously came through total knee and hip replacements, pacemaker surgery and pneumonia.
Coleman’s other surgeries and procedures were very traditional. This last one was not. Amin Al-Ahmad, MD and Paul Wang, MD, used a robot-driven assisting arm that hovered over Coleman, performing precision movements as directed by a joystick held by Al-Ahmad, seated a few feet away.
“My vision is that this technology will allow us to do things we haven’t been able to do previously,” said Wang, director of the Cardiac Arrhythmia Service. “We won’t have to compensate as we do with our hands and we’ll have a device that works in a 360-degree field.”
The robotic arm and joystick combination was recently added to the Hospital’s options for cardiac care. Amin Al-Ahmad, MD, associate director of the Arrhythmia Service and Director of the Cardiac Electrophysiology Laboratory, served as a design consultant for the manufacturer of the new device and has accumulated some of the most extensive experimental experience with the device in the world.
The appeal of consistency and fine motor control have made robot arms an appealing new adjunct to a variety of surgical procedures at the Hospital in areas including urology and gynecology.
For Coleman’s procedure, Al-Ahmad threads a special catheter through a blood vessel that leads to his patient’s heart, guiding it delicately within the blood vessel. Once the catheter is inside the heart, precision is important to accomplish what Wang wants: to find the cells responsible for the electrical activity that caused Coleman’s heart to beat irregularly. After zeroing in on the particular cells, Wang zaps them with lethal amounts of radiowaves, enough so the cells are permanently damaged and do not cause Coleman’s problems again.
The robotic arm Al-Ahmad and Wang use is manufactured by Hansen Medical; Wang said he owns stock in the company.
With the robot to help, physicians are able to finish the surgery more quickly. The robot also performs movements the same way every time, which can improve the reliability of the procedure. “It just makes so much sense,” Wang said. “My vision is that this will allow us better success, to do procedures in a much more straightforward way.”
In cases like Coleman’s, the robot ablation made sense because, “We knew where to go,” Wang said. “His arrhythmia was anatomically fairly well defined. We knew where it was going to be.”
The robot also overcomes the element of human fatigue, Wang said. “Standing at the table for hours is very tiring and that exhaustion can make it difficult to consistently reproduce the required fine movements” he said. Younger physicians training with the robot will probably have an easier time of learning the new approach. “The joystick is very much a modern interface, especially for those younger physicians who have grown up with electronic games.”
Using a robot also means that procedures can be practiced on a simulator until the movements are familiar and the procedure can be completed more quickly. “The future is for a physician to import a scan of the patient’s heart and to go through the exact steps he or she will use during the procedure," Wang said. "This will revolutionize how we perform heart rhythm procedures.”
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford. For more information, visit http://stanfordmedicine.org.