St. Vincent surgeon to train others in robotic aorta work, is ready to expand skills

By JULIE M. McKINNON
BLADE STAFF WRITER

With aortic blockages of five patients successfully repaired using robotic surgery, Dr. Bernardo Martinez is ready to train fellow surgeons on the approach as well as similarly tackle small aneurysms in another federally approved study.

The Toledo vascular surgeon, who is medical director of minimally invasive surgery at St. Vincent Mercy Medical Center, is the only doctor approved by the U.S. Food and Drug Administration to perform such surgeries.

Dr. Martinez is using the da Vinci Surgical Systems from Intuitive Surgical Inc.

Traditionally, surgeons have made an incision from sternum to groin to reconstruct an aorta, which runs down the body near the spine behind the heart and lungs. Exploring other methods to successfully minimize such incisions is paramount, Dr. Martinez said.

"It's too brutal - it's too cruel," he said of the traditional method.

With robotic surgery, Dr. Martinez is able to reconstruct blocked or weakened aortas by creating a series of small incisions, through which a camera and surgical instruments are inserted.

Decreased blood loss, pain, chance for infection, and recovery times are advantages of robotic surgery. Another advantage, Dr. Martinez said, is speed.

Repairs need to be done quickly after an aorta is clamped so blood flow can resume, and he has had good success with da Vinci, he said.

A patient's abdominal aortic aneurysm first was repaired robotically in 2002 in Amsterdam using a different system, Dr. Martinez said.

He has had FDA approval with the da Vinci since 2003, but patient criteria were too strict to find eligible candidates, he said.

Last year, Dr. Martinez was approved by the FDA to use the da Vinci system for patients with blocked abdominal aortas, and the regulatory agency also has loosened eligibility criteria for those with abdominal aortic aneurysms, he said. The procedure is less complicated for patients with blocked abdominal aortas, Dr. Martinez said.

The FDA does not comment on ongoing studies, a spokesman said.

Of the five patients with blocked abdominal aortas he has repaired since July using the da Vinci, three were done completely robotically, Dr. Martinez said. An additional, small incision was done with the other two patients after Dr. Martinez determined their surgeries could not be completed robotically, he said.

"This is about like military tactics," Dr. Martinez said. "The bottom line is safety."

Dr. Martinez said his next step with blocked abdominal aortas will be training other surgeons to do reconstruction with da Vinci, a system found in many hospitals both locally and nationally.

He will do the same with abdominal aortic aneurysms, which can be fatal if the vessel bursts, once he has proved the device is safe to use on patients, he said.

Reprinted with permission of The Blade
Contact Julie M. McKinnon at:
jmckinnon@theblade.com
or 419-724-6087.