Top Docs 2016: Aye, Robot

When there’s a mechanized middleman, some surgical treatments can be delivered faster and more efficiently.

Illustration by Doug Chayka

Patrick Muck, MD, surgeon
Chief of Vascular Surgery, Good Samaritan Hospital

—As told to Alyssa Brandt

“All minimally invasive procedures, be they gall bladder surgeries, urology surgeries, or OB/GYN procedures, benefit from the precision of robotic technology. For minimally invasive vascular procedures, you typically start at an access point, like the femoral artery in the groin, and insert a tube. Once we’re inside the artery, we use a variety of catheters that have different shapes or angles to navigate to the heart, the carotid artery, or aorta. Sometimes the blood vessels are really windy, like those road signs you see. If we try a catheter with a 30-degree angle and it isn’t working, it has to be removed and exchanged for a different one. Another issue in vascular surgery is stability. If the arteries are weakened by disease, it can be hard to keep them stable while we deliver a stent or chemotherapy drugs to a tumor. The Magellan addresses both of these issues by giving us navigational precision and added stability.

The other advantage to the Magellan system is that you can step away from the radiation. With minimally invasive procedures like these, the patient is given dye and we use an X-ray source to look inside the body. The X-ray source throws radiation all around the room. We’re getting radiated to kingdom come and back. We have shields in the operating room and we wear our lead—it’s even in our caps and glasses now—but nothing is bulletproof. The patient gets a one-time exposure, but for the procedural team, it’s an occupational hazard. Every time you can double your distance from the radiation source, it cuts your exposure by 75 percent. The Magellan allows us to be 10 feet away from the patient and control the system from a console.

Thirty million Americans have arterial disease due to things like smoking, high cholesterol, and diabetes. Pulmonary embolisms—blood clots that break off and travel to the lungs—still kill 300,000–400,000 people a year. Every family is going to have someone with a vascular problem at some point, be it a blood clot, or a carotid artery blockage that can lead to stroke, or an aneurysm. We can go in, put in a stent or a filter and you go home the next day with nothing more than a Band-Aid at the entry point. Today, I do about 10 percent open surgeries and 90 percent [minimally invasive]. When I started it was the opposite. The traditional image of the surgeon being right there over the patient isn’t gone, but it’s changing.”

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