ROBOTIC TECHNOLOGy

Robotic Technology eliMiNATes Need foR suRgeRy iN TRANsPlANT PATieNT

By Erin Fairchild

Charles Brennen

Charles Brennen received what felt like the most important phone call of his life. As he rushed to The Methodist Hospital two years ago, he reflected on how blessed he was to be granted a second chance on life — a new lung that would enable him to breathe normally. Something he hadn’t been able to do for years.

Spending his golden years doing what he loved most — working alongside his kids and their families at their Texas cattle ranch — was put in jeopardy 10 years ago when his lungs gave out due to asbestos poisoning. He spent three years on a transplant waiting list, desperately hoping he would live long enough to receive a new lung but also struggling with the notion that someone must die for him to live. And yet, that day had come.

The new lung provided the 72-year-old retired marketing executive with strength and a newfound ability to enjoy life again, but shortness of breath started creeping back last year. After seeing his doctors, he learned that his pulmonary artery, which carries unoxygenated blood to his new lung, had narrowed. Diagnosis: pulmonary artery stenosis.

“Brennen was growing weaker each day because his new lung wasn’t being fed the blood it needed to work effectively,” says Dr. Scott Scheinin, associate surgical director of Methodist’s Thoracic Transplant Program.

This was the first time in the United States that a robotic catheter was used outside the heart.

Unclogging the pipeline

Physicians use stents (mesh tubes) to prop open clogged arteries and restore blood flow to the lungs. But in Brennen’s case, a stent could not be used because his artery was too twisted to maneuver a catheter (used to carry and deploy the stent) up from the groin to the damaged artery. Furthermore, the placement of the stent was hampered by the rhythmic motion of the heart as it distributes blood through the artery to the lungs.

“In the old days we would have to take a patient back to surgery to repair a narrowed pulmonary artery. It’s a difficult spot to reach — a long, winding course under ideal circumstances,” Scheinin says. “But now, new robotic technology helps physicians navigate to the right spot and, more important, eliminates the need for transplant patients to undergo another surgery.”

In a first-of-its-kind procedure, Dr. Alan Lumsden, chair of the Department of Cardiovascular Surgery at Methodist, and Dr. Miguel Valderrábano, chief of the Division of Cardiac Electrophysiology, used a robotic catheter to place a stent in Brennen’s pulmonary artery and save his transplanted lung.

“The new stent carries more blood to my lungs, keeping them healthy and replenished with the oxygen they need, so I have more stamina,” says Brennen, a father of five and grandfather to four girls. “Now I can get back in shape, get out to the ranch, feed the cattle and see if we have any new calves running around.”

Lumsden and Valderrábano used a Sensei Robotic Catheter System designed by Hansen Medical for use inside the heart to successfully reach the narrowed part of the pulmonary artery.

So flexible it can wrap around a dime, the Artisan Extend™ Control Catheter improves access to complex anatomy.

“The robot helped us maneuver through a complicated series of twists and turns in Mr. Brennen’s vascular anatomy,” Valderrábano says. “It also helped compensate for the motion of the beating heart so we could place the stent safely and accurately, providing his new lung with a ready flow of oxygenated blood.”

With successful implantation of the stent, Brennen avoided being placed again on the lung transplant list.

This was the first time in the United States that a robotic catheter was used outside the heart. Valderrábano used 3-D guided imaging to direct the robotic catheter to precisely the right spot to place the stent. The team performed the procedure in a catheterization lab at a workstation console next to where the patient was lying on the table.

A high-tech joystick allowed Valderrábano to manipulate the catheter from a puncture hole in the patient’s groin, through the vascular system and into the pulmonary artery that connects the heart to the lungs. The joystick mimicked Valderrábano’s hand movements to control the catheter in a natural, intuitive way.

Once the catheter reached its destination, Lumsden placed and deployed the stent in its final resting place. Expertise and training

Valderrábano is one of the country’s foremost experts in the use of a robotic catheter, having completed more than 125 procedures using the robot, primarily to treat atrial fibrillation (irregular heartbeat). He has worked with Hansen to improve quality and reliability of procedures using the robot, and the manufacturer recently moved its international training center to the Methodist DeBakey Heart & Vascular Center.

Physicians come from around the world to learn and hone their skills at Methodist’s new Vascular Research Laboratory, where they use the Sensei, other robotic technology and simulation suites to research new, more effective and safer methods of performing cardiac and vascular surgery.

Valderrábano says experience brings improved outcomes for patients. “Physician training is of utmost importance to ensure patient safety when using a new robotic device rather than manual manipulation of a catheter,” he says. “We provide experience, plus the tools and simulation environments necessary to bring physicians who are new to this technology up to speed without ever ‘practicing’ on a live patient.”

As for Brennen, he’s breathing normally and back on track with renewed vigor. Not eight feet from his front door sits a gift from his son, a top-of-the-line treadmill. “I guess I can’t avoid exercising anymore,” he says. “You walk right into it when you open the door.” n

“Robotic technology helps physicians navigate to the right spot and, more important, eliminates the need for transplant patients to undergo another surgery.”

Seated at the workstation, the physician’s hand motion is translated to the control catheter located inside the patient.