"He is like a second god. One god is up there, and Dr. Poston is here for us," said Sabah Rowshan.
Rowshan, an immigrant from Bangladesh, is grateful for the results of the coronary bypass surgery that Dr. Robert Poston performed on her uncle.
Even though the God-Poston partnership is a commendable one, it is another option, a new technology, that may increase the odds of success for heart-disease patients: a robot.
Currently, U.S. hospitals have about 800 surgical assistant devices, or S.A.D, as the robots are known in the medical field.
But sad is not at all the feeling that has lingered in dozens of families of those undergoing complicated operations with the assistance of these $1.5 million-a-piece machines.
The robots were originally created by the U.S. Department of Defense to perform battlefield medical operations. The devices already have been used in prostate surgeries across the country.
However, no medical center in Massachusetts has used the robot, named "da Vinci," for cardiac surgery. Until now.
In March, Dr. Robert Poston relocated from Maryland, where he performed 160 robotic surgeries, to be chief of cardiac surgery at Boston Medical Center. In the past three months, he has performed more than 20 robotic surgeries.
"I am at a point where I need to get surgeries to build up more confidence and grow the reputation of the field," says the doctor, who says that many doctors are still reluctant to adopt the new technology.
Although opposing physicians feel hindered by the loss of tactile function, or the ability to "feel" the patient's tissue, the technology's advantages are various. It's less invasive than the traditional open-chest surgery.
With "da Vinci," a surgeon only needs to do three 2.5-inch incisions on the left side of the patient's chest. And because the heart is still beating - no need for pumps or lung machines - patients experience a much faster recovery period, cut from 90 to 30 days.
"Hollywood has dramatized our practice. There's no blood spilling. We work in a controlled environment," says nurse Lance Maggiacomo.
In addition, says Dr. Poston, the risk of infection or post-operation side effects is 10 times less likely to happen, and the hospital stay is reduced by half as well.
Dr. Poston has toured the country to promote the procedure. In a study titled "Superior Financial and Quality Metrics with Robotically-assisted Coronary Artery Revascularization," Dr. Poston described the new technology as being able to improve patients' satisfaction by reducing complications and putting them back to work in a shorter period of time.
The most common causes of coronary blockages, or an accumulation of plaque in the heart's arteries, are smoking, diabetes, a diet reach in fatty ingredients, and high blood pressure.
A bypass surgery, to treat the blockage, is the transferring of one portion of a healthy artery to replace another clotted one.
Last month, EthnicNewz.org visited Boston Medical Center (BMC) to "test-drive" the robot.
To use all the powers that "da Vinci" can offer, a doctor has to sit, positioning his head in a video-game-like monitor. The human visual capacity can be enhanced 20 times in there.
Then, the physician squeezes two fingers of both hands to get a grip of the robotic elbows. No tremor is absorbed by the machine; the sensation is really of having super-control, with any miniscule vessel becoming impossible to miss.
But even with all the technological improvements, Dr. Poston admits, "no machine will ever be as precise as the human hand."
The analysis of surgery costs is also part of the debate about the advantages of operating with robots. While the traditional procedure can cost up to $12,581, the robotic one can go for $13,946, which includes $4,309 to offset the $139,000 per year that a robot requires in maintenance costs.
Dr. Poston compared 100 patient cases in a study that will be published in the Annals of Surgery in September, and concluded that "robotic bypass incurred higher cost for operative supplies, and OR [operating room] time, but significantly cheaper for postoperative course attributed to drugs, labs, and ICU stay."
Last week, EthnicNewz.org went back to BMC to experience a live, robotic cardiac surgery. Lying on the bed was a 49-year-old local dentist who had felt nearly-unbearable chest pains while skiing in Utah. He needed a bypass in two of his heart arteries.
Physician assistant James McCann says the patient is actually very fit, but has a long family history of coronary disease.
The mood in the operation room is very calm. McCann draws on the scrub-like surgical paper what the bypass will look like when the six-hour procedure is complete.
On the other side of the O.R., Dr. Poston harvests for the best mammary arteries inside the patient's chest cavity
There's no need to saw bones, the robot's arms flow freely underneath the ribs, respecting the delicate beauty of hundreds of veins. Only an experienced physician can be confident enough to conduct a robot, knowing his way around the insides of a human body.
The micro-camera catches a glimpse of the beating heart, while Dr. Poston communicates with medical students, witnesses from another room.
McCann says this patient was referred to a traditional bypass surgery, but chose to do it robotically.
"If you have too many vessels diseased, [that] would preclude...you [from being] able to have a robotic surgery. How many lesions you [have] and [where] they are will determine the best procedure," says McCann. The nurse refers to the hardship the robot would encounter to perform surgery if the blocked artery is located to the right of the heart.
At the other side of town, Sabah's uncle, Mohammed Tarique, is recovering from the same double-artery surgery. He has been eating lots of chicken soup.
He was flying from Bangladesh, a country dismembered from Pakistan in 1971, to New York, for a summer vacation with family members in Brighton, Mass., when the chest pains started.
"I had to lie down in the (JFK) airport when we landed. I had very strong pains", he said.
The 55-year-old auto spare parts dealer embarked to Boston anyway. Upon landing at Logan he was rushed to Boston Medical Center. Not long after that, Dr. Poston entered the room to give the news: With only 20 percent of Tarique's heart pumping blood, he needed surgery.
The dilemma for his family began when the robotic technology was raised as the best option. At least 20 family members had a long debate about the idea.
Should Tarique, they say, really be one of the first Bangladeshis to undergo the new procedure? His wife, a devout Muslim, prayed for an entire day in search of an answer. Another uncle had second thoughts, too.
"Our family is really picky on doctors. And a lot of people hesitate to be treated by young physicians like Dr. Poston. But the way he explained the procedure, it just felt ok for us to do it," says Sabah Rowshan.
Only three days after the April 29th surgery, Tarique was released from the hospital.
"I had to take the risk, it was doing or dying. It was like a miracle for me," said Tarique after the 7.5-hour surgery.
"But I am feeling very glad that this can be done. Thanks for Dr. Poston; he is a man of courage and a great doctor."
source: EthnicNewz.org
Story and photos by Eduardo A. de Oliveira
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