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Robotic Surgical Services: Donald Carlson

Although he'd had heart bypass surgery in the 1980s, Donald Carlson of Port Orchard didn't recognize the symptoms of returning cardiac problems at first. "In the fall of 2007, I was feeling a little pressure in my chest," Don recalls. "Then I had to cut my daily walks down from three miles a day to just a mile or I'd start getting chest pain. In January, 2008, I finally went to see the doctor."

It turned out that the retired airline customer service agent was experiencing symptoms of coronary artery disease. At that point, he had two arteries that were partially blocked, and one that was completely blocked.

By the end of summer, Don couldn't walk at all without chest pain. Even getting up from a chair was challenging. "At that point, I thought I probably needed more open heart surgery," Don says. That prospect was complicated by two things, though. Don has a form of hemophilia, an inherited blood disorder that can cause uncontrollable bleeding. Don's blood would require special preparation for surgery. Don's previous heart surgery had also left his heart bound to his breast bone by scar tissue, which made implantation of new stents to open his coronary arteries impossible.

Don's complicated case was transferred to Northwest Hospital & Medical Center as his physicians and surgeons looked for solutions.

Nahush Mokadam, MD, a cardiac surgeon with UW Cardiothoracic Surgery, provides cardiac surgery services to Northwest Hospital patients through a partnership with the University of Washington. He says a traditional surgical incision through the sternum would have been likely to injure Don's heart further. After careful study of Don's condition, Dr. Mokadam decided on a different approach to the surgery.

"Don's heart was most lacking blood and oxygen where one of his previous bypasses had failed," he says. "Since I was using the da Vinci S surgical robot at Northwest Hospital on a lot of more conventional cardiac surgeries, I thought it might work to use the robot to approach the left side of Don's heart through the left ribcage."

The da Vinci S robot creates a "virtual" extension of the surgeon's eyes and hands, using 3D, high-definition vision and four robotic "hands" as extensions of the surgeon's own to go where human hands typically cannot. Northwest Hospital is also the only local health facility where cardiac surgeons can use the da Vinci system.

To benefit from robotic surgery, though, Don had some work to do. His wife Raelene was enlisted by the surgical team to inject clotting factor into Don's arm for several days before the surgery. The clotting factor would help prevent excess bleeding during and after the surgery. In fact, the tactic was so successful that Don needed no blood transfusions during surgery or recovery, which Dr. Mokadam says is highly unusual for a hemophiliac. This is consistent with Northwest Hospital's superior record for controlling the need for blood transfusions during cardiac surgery. While the Washington State average for transfusions during cardiac surgery in 2008 was about 29%, Northwest Hospital administered transfusions during cardiac surgery only 21% of the time.

Dr. Mokadam, assisted by Dr. Gabriel Aldea, another member of the UW Cardiothoracic Surgery team, used the robot to complete much of the initial part of the single bypass procedure, before converting to traditional, open surgery to place the bypass onto the heart muscle. "We used the robot to prepare the artery we used for the bypass. Being able to do this with only a small incision by the surgical robot was a big benefit to the patient."

The entire procedure went smoothly, and while Don's convalescence was challenging, his quality of life improved significantly following his recovery. He is now able to do a lot more walking and deal with the routines of daily life with ease. "It was gratifying to be able to overcome a lot of challenges and do this second heart bypass for Don with minimal risk. He was able to regain his quality of life, which was our goal," Dr. Mokadam says. He adds that Don also benefited from superior nursing care in the hospital's intensive care unit during his recovery.

Northwest Hospital's partnership with UW Cardiothoracic Surgery enables the hospital to provide a full range of cardiac services, from routine diagnostic procedures to sophisticated interventional cardiac procedures and open heart surgery.

read Linda Del Monte story  

To see if you are a candidate for surgery using the da Vinci S Robotic Surgery System, speak with your physician or surgeon. For a list of physicians who perform robotic procedures at Northwest Hospital, click here.

For more information on the da Vinci robot, visit www.davincisurgery.com.

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