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Da Vinci: the robot of your heart's future?

If there's surgery in your heart's future, it may look like this: A doctor sits, shoeless, at what could be a video game console, manipulating instruments that resemble steel chopsticks with pincers on the ends.

The difference for you is that instead of having your rib cage cracked open using scalpels and saws, the instruments are manipulated through a series of four small holes in the chest.

It's a da Vinci surgical robot, an elaborate, expensive — Saint Joseph Hospital paid $1.25 million for each of its two da Vincis — machine that's already popular nationally. It allows for smaller incisions for surgeries such as hysterectomies and prostatectomies (the full or partial removal of the male prostate gland). That means, in many cases, less invasive surgery and a shortened recovery time.

While Central Baptist, the University of Kentucky and Saint Joseph all use the da Vinci for various surgeries, Saint Joseph is currently the only Lexington hospital that is using it for some cardiac surgeries. If you're someone who needs five or six bypasses, you're still going to be going the standard route, which involves opening the rib cage. But surgery to replace the mitral valve — blood flows through the valve going from the left atrium to the left ventricle — can be done with a da Vinci.

But using da Vinci also means that surgeries will be more expensive — about $2,000 more for prostate surgery, says Dr. Stephen Strup, chief of the division of urology at UK, who does prostate surgery with and without the da Vinci machine. He performed former UK football coach Hal Mumme's 2009 surgery with the da Vinci.

Strup acknowledges that teaching hospitals are more likely than others to have da Vincis, but other types of hospitals are going to increasingly have them — and advertise them to consumers.

While surgeries using robots are more expensive, it's unclear whether the outcomes of such surgeries are better or worse than traditional operations. But many patients are asking for the surgery as they hear about it or see ads for it.

The advantage that the da Vinci brought into the operating room, Strup says, is to provide "a 3-D picture for that surgeon sitting at the console."

Some patients like their surgeon at the operating table with them, he says, while others don't mind if the surgeon is gazing at a three-dimensional rendering of their insides from a console that can be manipulated by both hands and feet.

During a recent mitral valve replacement surgery at Saint Joseph, Dr. Michael Sekela peers into the da Vinci console, while Dr. Theodore Wright stands next to patient Julie Hughes, 46, of Georgetown, who is covered in surgical draping and tilted on her side.

The Smashing Pumpkins play in the background. The count in the operating room: 10 people, one da Vinci robotic assistant, one Sirius Radio.

Sekela, shoes parked neatly in the operating room corner facing South Broadway, puts the da Vinci through its paces.

Look through the eyes of the da Vinci machine, as Sekela does, and it's like playing a super video game with three-dimensional clarity. A piece of surgical thread swings toward the eyes like a giant blue lariat.

The device to repair the valve itself looks like a ponytail scrunchie, but is smaller and more rigid; it is threaded into place by a new device that power-sews the item into place. Still, says Strup of UK: "Robotic surgery is still in its infancy."

Technically, Strup says, the da Vinci is not a robot, since it is controlled by a surgeon sitting at a console. Rather, it is a robot assistant.

Eventually, he thinks, the robot-assisted surgery will become more sophisticated, to the point where the extra cost is justified by uniformly better results and quicker recovery times.

"Patients love it," says Sekela.

Patients are usually in and out in two to three days with the da Vinci procedure, compared with three to five days for a standard procedure. They recover, generally, within two weeks, versus six weeks for a standard procedure.

Says Evelyn Fugate, a nurse who helps supervise the da Vinci equipment: "It's just less invasive. We don't have to open the sternum. That makes the biggest difference."

Saint Joseph staff rehearsed on pig hearts before going live on humans with da Vinci.

The da Vinci isn't taking over all heart surgeries — yet. It can perform mitral valve procedures, removal of intracardiac tumors and coronary artery bypass procedures.

Sekela, who performs 300 to 350 cardiac procedures every year, plans to do 35 to 40 with the da Vinci over the next year. And while tactile feedback may be missing with da Vinci, the instrument can provide extensive visual feedback by going as deep as six to seven inches into the poke holes.

Central Baptist plans to begin using the da Vinci for cardiac care within the next six months, says spokesman Ruth Ann Childers, and is exploring its use in colorectal surgery. It is already in the top 5 percent of hospitals in the nation in using the da Vinci for gynecological surgeries.

Hughes, who had the mitral valve surgery on Monday, said Tuesday afternoon that she was "really tired and sore." But, she said felt that the da Vinci "is a lot better than the alternative methods."

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