Ralph Damiano says he never tires of his job, and it's hard not to believe him. A professor of surgery and chief of cardiac surgery at the Washington University School of Medicine, Damiano splits his time between teaching medical-school classes, training new residents, and conducting research in his specialty, computer-assisted coronary surgery. He also performs about four operations a week. All of this puts him squarely at the intersection of theory and practice in cardiac surgery, a situation he clearly cherishes.
"The driving passion you have if you're a physician is in your clinical work," he says. "But, at the same time, I would find my life tremendously empty if all I came in and did every day was clinical work."
A genial fellow with the smooth, reassuring voice you'd like to hear from the man who's about to reach into your chest, Damiano performed the first computer-assisted coronary bypass graft in North America in 1998. Two years later, after conducting a series of FDA-approved trial runs of the operation at Penn State University, he arrived at WU, where he continues to refine the procedure and teaches it to his protègès.
The setup for a computer-assisted bypass graft--a blood-vessel transplant designed to reroute blood flow around a narrowed or clogged artery--is marvelously simple. About five feet from the operating table sits a console with a video screen and joysticks. Each joystick controls a robotic arm that acts as an extension of Damiano, performing surgical procedures like incisions and suturing. A third arm with an illuminated camera, called an endoscope, is voice-controlled.
Using the console is "very different for a surgeon, particularly since we're so used to having our hands inside a patient," Damiano acknowledges. "That intimate contact is, I think, a lot of the appeal to surgery." But he's gotten used to the joysticks, he says. "You're still very much tied up in the procedure."
The most important benefit of the computerized system, known as ZEUS, is tremor reduction: The software is designed to minimize the shaking of a surgeon's hand to prevent potentially devastating slips. The result is a breakthrough in microsurgery--the ability to operate successfully on smaller and smaller vessels.
Endoscopic microsurgery is "impossible to do by hand," says Damiano, who studied under physicians David Sabiston and James Cox at Duke. "For the first time in the history of surgery, we are able to do technical maneuvers and procedures that exceed normal human dexterity. One day we could be able to operate on individual cells."
But the field is still at the fledgling stage. Robotics is used in only a few of the hundreds of surgeries performed at the WU Medical Center in a year. Most of the time, even Damiano still operates using the traditional hands-on method.
So far, though, the results with robotics have been overwhelmingly positive: Surgeons can operate on a still-beating heart, without the benefit of a heart-lung machine. And endoscopic surgery makes it possible to replace the typical massive chest incision with a few Phillips-head-sized holes, thus cutting recovery time and complications dramatically. The ability to operate remotely on a patient might eventually lead to long-distance surgery, controlled by someone up to 3,000 miles away from the patient.
That's still on the distant horizon, says Damiano. But, "even in these early stages, we can see what the potential of it is. I think eventually we'll change how surgery is done. How long that might be, whether five or ten years, I don't know. But I do know it will happen."