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Welcome to the Third Issueof
Our "Spotlight Feature" Series in which we will highlight;
Cardiothoracic Surgeon: W. Douglas Boyd, MD, BSc, FRCS(C)
Dr. Boyd is recognized for his pioneering work in cardiothoracic surgery and for his use of robotic-assisted surgical systems.
In 1999 he completed the world's first closed-chest, beating-heart coronary artery bypass surgery, (CABG) using the Zeus Surgical System manufactured by Computer Motions Inc.
In September 1999, Dr. Boyd completed the world's first closed-chest, beating-heart coronary artery bypass surgery with the use of the ZEUS Robotic Surgical System, and is recognized throughout the worldwide medical community for his pioneering work in cardiothoracic surgery and the use of robotic surgical systems.
Dr. Boyd is also recognized for performing the first human extracellular matrix xenograft implant for cardiovascular repair in March 2006.
He was the head of the Department of Cardiothoracic Surgery at the Cleveland Clinic in Florida from 2002-2009.
In May of 2009 Dr. Boyd agreed to be the principal investigator for Amadeus® clinical trials manufactured by Titan Medical Inc.(TMD). “I am extremely pleased to join Titan as the principal investigator for upcoming trials of Amadeus®,” said Dr. Boyd. “The company’s robotic surgical platform is indeed evolutionary and overcomes the technical hurdles that are currently faced by surgeons using robotics in surgery.”...read full press release
In August of 2009 he was named Professor of Surgery, and Director of Robotics and Biosurgery at the University of California, Davis. He is board certified by the Royal College of Physicians and Surgeons of Canada in general and cardiothoracic surgery.
As principal investigator in numerous clinical research trials, Dr. Boyd's research has focused on invasive robotic surgery, image guided minimally invasive cardiothoracic surgery, minimally beating heart surgery, and improving patient safety in cardiac surgery. He has been an invited lecturer at regional, national and international symposia and conferences on his specialty interests. Dr. Boyd has authored or co-authored book chapters in medical textbooks on robotic cardiac bypass surgery and computer-assisted interventions among many other heart-related topics and has published numerous abstracts on his specialty interests.
He has performed robotic assisted CABG since 1997, (over 500 cases) and published or co-published over 50 papers on robotic surgery, developed robotic surgical techniques and mentored dozens of surgeons on the technique of robotic CABG.
Current areas of research include pioneering work in cardiac tissue regeneration with extracellular matrix/stem cells.
Dr. Boyd currently practices in California where he resides with his wife and two children.
World's First Closed-Chest Beating Heart Bypass Surgery Successfully Performed
October 6, 1999
Computer Motion Inc. and London Health Sciences Centre Partner to Pioneer New Robotically Assisted Minimally Invasive Cardiac Surgery to Minimize Operative Risks and Patient Trauma.
Computer Motion Inc. (NASDAQ:RBOT), the world leader in medical robotics, announced today that the world's first endoscopic beating heart coronary artery bypass graft (CABG) was recently performed at the London Health Sciences Centre in London, Ontario, Canada.
This ground-breaking minimally invasive cardiac operation was performed with Computer Motion's ZEUS(TM) Robotic Surgical System and eliminated the two greatest sources of patient trauma associated with conventional open heart surgery: the large incision and the heart-lung machine.
In conventional open heart surgery, the surgeon uses a 12-15 inch chest incision to access the heart and a heart-lung machine to administer cardiopulmonary bypass (CPB) to the patient and stop the heart. Studies show that eliminating CPB may reduce the risk of stroke and neurological complications associated with a stopped heart approach. Equipment costs can also be reduced. Additionally, the pain and trauma inflicted upon a patient is directly affected by the size of the surgical incision.
Douglas Boyd, MD, BSc, FRCS(C), Director of the Minimally Invasive Cardiac Surgery Program of the London Health Sciences Centre, and Alan Menkis, MD, Professor of Cardiac Surgery of the University of Western Ontario, were able to perform this CABG operation through a few tiny "ports," through which 3mm and 5mm surgical instruments were inserted while the heart continued to beat during surgery, supplying the body with naturally oxygenated blood.
Menkis stated: "The patients are the real beneficiaries of this new endoscopic cardiac procedure because of the significantly reduced pain and trauma, shorter convalescent periods and the expectation for excellent long-term results. For example, we were extremely pleased to see the patient mobile the day after surgery and already back to enjoying life on his dairy farm."
Boyd stated: "The ZEUS System is the key to enabling this endoscopic beating heart procedure. With ZEUS, I can perform the precise, minute coronary sewing within the very small space available in the chest cavity while the heart is beating. The compact system design also allows for the surgical assistant to work with me at the operating table, which I believe is crucial for the success of this procedure."
da Vinci vs Zeus; Historical Intuitive Surgical / Computer Motion patent infringement lawsuit
ZEUS Surgical Robot
Back in 2002,
competition between Intuitive Surgical Inc. and Computer Motion Inc. began to mount fiercely, as the market became ready to embrace surgical robotic technology. Those days, the sales numbers were still very low. (Zeus: 30 units sold in the USA, 15 in Europe, 5 in Asia; da Vinci: 50, 34, 5, respectively.)
First, Computer Motion sued Intuitive Surgical for infringement of nine patents. Then, Intuitive and IBM filed the patent infringement suit against Computer Motion in reference to the voice-controlled technology. In 2002, the District Court for the Central District of California ruled that the da Vinci Surgical System literally infringed Computer Motion's 6,244,809 patent. Then, a federal jury in 2003 issued a ruling requiring Computer Motion to pay Intuitive and IBM $4.4 million for infringing a patent covering aspects of Intuitive's system.
On March 7. 2003 the two companies announced that "they are merging into one company combining their strengths in operative surgical robotics, telesurgery, and operating room integration, to better serve hospitals, doctors and patients." This meant a goodbye to Computer Motion. "The reason that Intuitive paid a premium price for CMI is that they believed that they would lose one of the patent infringement cases that CMI was pursuing. The reason that CMI agreed to the acquisition, is that (while they believed they would ultimately prevail in the patent infringement case) they simply didn't have the financial resources to sustain them over the period that IBM's deep pockets would allow Intuitive to keep the litigation going."
After the merger, the Zeus Robotic Surgical System was discontinued, the support for the product decreased and many of the engineers were fired, as they did not want to leave Santa Barbara for Mountain View.
CMI CEO (at the time of acquisition), Bob Duggan is now the largest individual shareholder in Intuitive. Yulun Wang, founder of Computer Motion became the CEO of inTouch Health, which developed the RP Endpoint Devices
Robotic-Assisted Cardiac Surgery at UC Davis Health System
Cardiothoracic Robotic Surgery at UC Davis
About Coronary Artery Disease
Heart disease is caused by a condition in which fat, cholesterol, calcium, and other substances found in the blood build up to create plaque inside the coronary arteries, which supply the heart with oxygen-rich blood. This condition, called atherosclerosis, results in a narrowing of the arteries and reduced blood flow to the heart. As the vessels become more clogged with deposits, blood flow can slow down or stop, causing chest pain, shortness of breath or a heart attack. Depending on the severity of the condition, treatment options to ease symptoms and reduce the risk of a heart attack may include an angioplasty, bypass surgery or both.
UC Davis Medical Center is one of only a handful of hospitals in the nation that can offer a robotic-assisted bypass in conjunction with an angioplasty. This unique combination of state-of-the-art procedures provides patients with the durability benefits of conventional bypass surgery, plus the recovery benefits of minimally invasive procedures. It is the best of both worlds.
At UC Davis, the cardiothoracic surgery team specializes in treating patients with coronary artery disease using robotic-assisted, laparoscopic techniques. This procedure is performed without the need for a heart-lung machine and avoids a sternotomy, in which a surgeon makes an 8 to 10-inch incision down the chest, cuts through the breast bone and spreads the ribcage to access a patient's heart. The robotic-assisted procedure is minimally invasive, allowing the surgeon to work through several small incisions made between the ribs.
The robotic-assisted cardiac surgery team at UC Davis Medical Center
is led by W. Douglas Boyd, a professor of clinical surgery and medical director for cardiac robotics. Dr. Boyd exemplifies the Division of Cardiothoracic Surgery’s commitment to minimizing pain and length of convalescence, as well as improving outcomes and quality of life.
The robotic-assisted procedure allows a surgeon to work through small keyhole-sized incisions using tiny, precision-guided instruments. During a bypass procedure, the physician sits at a controlling console in the operating room while an assistant surgeon is at the bedside next to the patient.
Boyd views the operative field in 3D on a video monitor while he controls a set of robotic arms that precisely replicate his hand movements. In cases of coronary artery disease, the robotic-assisted procedure enables Boyd to use healthy arteries or veins from other areas of the body to bypass (go around) the narrowed coronary arteries and establish renewed and durable blood flow (revascularization).
Compared to traditional, “open” heart surgery that requires a large incision across the chest and cutting through the breastbone (sternum), patients undergoing a minimally invasive, robotic-assisted bypass should experience an easier and quicker recovery and much less pain.
W. Douglas Boyd, M.D.
UC Davis surgical team performs state's first robotic-assisted, multi-vessel cardiac bypass procedure February 17, 2010
Two cardiothoracic surgeons at UC Davis Medical Center have performed the first robotic-assisted, multi-arterial, cardiac bypass procedure in California. The surgery, which took place in late January, is a highly complex but minimally invasive operation that offers patients quicker recovery times and less blood loss than conventional open-heart bypass procedures.
The successful case, which involved a 49-year-old patient suffering from multi-vessel coronary artery disease, was also unique because it combined a robotic-assisted bypass with an arterial stent that opened the one secondary clogged vessel that could not be reached during surgery because of its position behind the heart. This highly effective combination of procedures is available at only a handful of hospitals in the nation.
The Society of Thoracic Surgeons. Print ISSN: 0003-4975; eISSN: 1552-6259.
FAQs about Robotic Assisted Cardiothoracic Surgery
Q What cardiac conditions can be treated with robotic-assisted surgery? A Led by Dr. W. Douglas Boyd, who performed the world's first closed-chest robotic-assisted, beating-heart, coronary artery bypass graft in 1999, the cardiac team currently offers robotic-assisted surgery for patients suffering from coronary artery disease. The team can do thoracoscopic, multi-vessel revascularization and it often collaborates with UC Davis specialists in cardiovascular medicine, who provide complementary services such as angioplasty and stenting, to offer every patient the full range of minimally invasive medical options.
Q How does robotic-assisted surgery work? A Working from a special console in the operating room, a surgeon operates several precision-guided robotic arms that hold and manipulate miniaturized instruments that are inserted through several keyhole-sized incisions in the patient. A small video camera, inserted through another tiny incision, provides surgeons with a magnified, 3-D image of the operating site. This expansive view allows doctors to see and avoid surrounding nerves and muscle. The robotic arms, with their full 360-degree rotation capabilities, enable surgical instruments to be moved with greater precision, flexibility and range of motion than can be done in a standard, minimally invasive laparoscopy.(Figure 1)
QWhat are the criteria for robotic-assisted surgery? A The type of treatment recommended for a patient’s condition always depends on many factors, including the type and severity of heart disease, age, medical history and lifestyle. Diagnostic tests are required to determine if you are an appropriate candidate for robotic-assisted cardiac surgery. Your surgeon will review the results of these tests to determine if the robotic-assisted heart procedure is the right treatment approach for you.
QWhy is there less blood loss with robotic-assisted surgery? A The use of the robotic surgical system means a less traumatic operation. The coronary artery bypass can be done thoracoscopically, between the ribs, rather than with a sternotomy, which requires an 8- to 10-inch incision down the chest, cutting through the breastbone (sternum) and opening the chest to access the arteries surrounding the heart which means patients typically experience significantly less pain and less blood loss when compared to conventional “open incision” procedures. Patients also tend to enjoy quicker recovery times. While every case is unique, the return to normal activities (except for lifting heavy objects and strenuous exercise) following a robotic-assisted bypass procedure may occur in a matter of weeks compared to seviral months with traditional open surgery.
QWhat are the risks of robotic-assisted surgery? A As with any major surgery done under general anesthesia, there is a certain amount of risk, including heart attack, stroke and death. Preoperative assessment of a patient’s overall health is part of the standard surgical evaluation at UC Davis Medical Center.
Working from a special console in the operating room, a surgeon operates several precision-guided robotic arms that hold and manipulate miniaturized instruments. Figure 1
Cardiac surgeons Dr. Douglas Boyd, Dr. Bruce Ferguson, and Dr. Nimesh Desai discuss interpretation techniques and assessment of SPY images taken during coronary artery bypass surgery.
Dr. Douglas Boyd
Dr. Boyd wows students at the Porterville Chamber of Commerce, Porterville Rotary Club and Porterville Unified School District’s career day.
November 7, 2012
students were left spellbound by the talk of Dr. Douglas Boyd, one of the world’s leading heart surgeons, who is using De Vinci Robotics. Dr. Boyd was the first to do a robotics heart surgery while the heart was still functioning. He did that surgery in 1999.
While robotics is relatively new to health care, Dr. Boyd said it is “now a measure of a good hospital.”
He explained that using robotics makes heart surgery less invasive and cuts down recovery time significantly. He said the idea was developed by the military looking for a means to do field surgeries without having to have doctors at the front lines. That was in the late 1990s and led to the robotic surgery of today.
“This is new technology, first generation stuff,” he told the students.
He also explained that the new technology continues to expand. “We haven’t seen anything yet. The best is yet to come,” he vowed, telling of new 3D technology and studies in robotics where brain waves are used to move the robotic arms, not the surgeon’s hands.
“The world is opening up in ways that’s going to be fascinating,” he predicted.
Douglas Boyd, MD, BSc, FRCS(C),
Address: UC Davis Medical Center - Cypress Building 2221 Stockton Blvd., Suite 2112 Sacramento, CA 95817 Phone: (916) 734 3861
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