matters of the heart

Houston cardiac surgeon outpaces much of the country in game-changing robotics

Dr. Kenneth Liao, chief of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke's Medical Center, is one of around 50 surgeons in the country considered experts of this new surgery robotics tool. Photo courtesy of Baylor St. Luke's

Dr. Kenneth Liao is pioneering a less invasive form of heart surgery at a time when distanced medicine has become more important than ever with the help of six team members and one robot.

As the chief of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke's Medical Center, Liao has performed 116 robotic cardiac surgeries since coming on board in 2019 (as of press time). With Liao at the helm, Baylor St. Luke's has become a top cardiac robotics program in the country and is the only hospital in Houston to practice this highly-specialized form of surgery.

Liao's four-armed robot friend is known as the da Vinci robotic system and was first designed to assist in battlefield procedures. Now on its fourth generation, the robot allows surgeons like Liao to treat heart diseases and conditions that typically would require open heart surgery through a one-to-two inch incision near the ribs. In many surgeries, it also allows surgeons to keep a patient's heart beating, lowering the risk of stroke.

"It's a totally game changing component to conventional surgery," Liao says, who's one of about 50 surgeons in the country with his level of command over the tool.

Once inside, the da Vinci robot uses tiny instruments to perform surgical practices from suturing to cutting to tying a knot all within the rigid chest cage, which in a typical open heart surgery would have to be broken to perform such tasks.

The surgeon, who's seated about 10 feet away from the patient, controls the tools through a joystick connected to a computer console that shows an enhanced 3D view of the patient's chest. Liao says the screen provides a better visual of the heart than if he was seeing it with his own eyes, as it magnifies the field of surgery tenfold. This method also gives surgeons a better view of areas of the heart that they cannot easily see from above during traditional procedures.

The da Vinci can be used for bypass, grafting, pacemaker, and valve repair surgeries, and it has been proven to result in less blood loss and a faster, less painful recovery. Similar technology has also been adopted for prostate and gynecological surgeries. "It gives you the advantage of minimizing the trauma," Liao says.

And though the da Vinci was developed years before the pandemic, it puts patients at a lower risk of exposure to any outside contaminants, Liao adds, as the robot alone is interfacing with the patient through a small port, compared to doctors, nurses, and assistants hovering over an open chest cavity.

"Technology will theoretically reduce a patient's exposure to COVID in the operation room," he says. "I think that's common sense."

Liao was an early adopter of robotics, when the technology was much less user friendly. He performed the first robotic heart surgery in the state of Minnesota in 2003 and has worked with the developers of the da Vinci ever since to help improve the product after many other surgeons dismissed it.

He says today there is a renewed interest in the highly technical process and he believes it will become an emphasis for younger surgeons.

"This generation of surgeons are young and they are very indebted to computer technology and games. For them looking at screens and controlling the hand joystick control is much more familiar than for the older generation that was trained 20 years ago." he says.

The incredible technology helps, too. "A lot of times, as surgeons, we train in the old way. It's very difficult to change the systems," he says. "You need a major technology revolution to change the teaching and training."

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Building Houston

 
 

Meet MIA — Houston Methodist's new voice technology assistant. Photo via Getty Images

Hey, MIA. Start surgery.

These are the words Houston doctors are learning to say in the operating rooms, thanks to a first-of-its-kind voice technology developed by the Houston Methodist's Center for Innovation in collaboration with Amazon Web Services. In the same way we use programs like Alexa or Siri to make our everyday tasks easier, the Methodist Intelligent Automation, or MIA, is allowing medical professionals to improve the way they interact both with technology and patients alike.

"There's been a push in the industry for a long time that people sitting behind computers and typing and staring at a computer screen is inadequate," says Houston Methodist Chief Innovation Officer Roberta Schwartz. "There's been a desire to return people back to each other rather than physicians and look at a screen and patients look at a doctor looking at a screen."

Currently in its pilot phase, MIA is working to do just that through two key functions that shift the way medical professionals work in what Schwartz calls the "era of electronic medical records."

The first is through operating room voice commands. Here medical professionals can run through a series or checklists and initiate important actions, such as starting timers or reviewing time of anesthesia, through voice instead of by typing or clicking, which can become cumbersome during lengthy and highly detailed surgeries. Information is displayed on a large 80-inch TV in the operating suite and following surgery all of the data captured is imported into the traditional EMR program. The technology has been prototyped in two Houston Methodist O.R. suites so far and the hub aims to trial it in a simulation surgery by the end of the year.

Additionally, the hub is developing ambient listening technology to be used in a clinical setting with the same goal. Houston Methodist and AWS have partnered with Dallas-based Pariveda to create specialized hardware that (after gaining patient permission) will listen into doctor-patient conversations, transcribe the interaction, and draft a note that is then coded and imported directly into the EMR.

"For EMR the feedback is that it's clunky, it's click-heavy, it's very task oriented," says Josh Sol, who leads digital and clinical innovation for Houston Methodist. "Our goal with the Center for Innovation and this technology hub is to really transform that terminology and bring back this collaboration and the patient-physician relationship by removing the computer but still capturing all the pertinent information."

The ambient listening technology is further off and is currently in user acceptance testing with clinicians.

"They've had some great feedback, whether it's changing how the note is created, changing the look and feel of the application itself," Sol adds. "All feedback is good feedback at this point. So we've taken it in, we prioritize the work, and we continue to improve the application."

And the hub doesn't plan to stop there. Schwartz and Sol agree that the next step for this type of medical technology will be patient facing. They envision that in the near future appointment or surgery prep can be done through Alexa push notifications and medication reminders or follow up assessments could be done via voice applications.

"It's all going to be of tremendous value and it's coming," Schwartz says. "We may be taking the first baby steps, but each one of these voice technologies for our patients is out there on the horizon."

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