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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Dr. Peter Hotez and Dr. Maria Elena Bottazzi have been recognized by Fast Company for their leadership in developing low-cost COVID vaccine. Photo courtesy of Texas Children's

This week, Fast Company announced its 14th annual list of Most Creative People in Business — and two notable Houstonians made the cut.

Dr. Peter Hotez and his fellow dean of the National School of Tropical Medicine at Baylor College of Medicine, Dr. Maria Elena Bottazzi, were named among the list for “open sourcing a COVID-19 Vaccine for the rest of the world.” The list, which recognizes individuals making a cultural impact via bold achievements in their field, is made up of influential leaders in business.

Hotez and Bottazzi are also co-directors for the Texas Children's Hospital's Center for Vaccine Development -one of the most cutting-edge vaccine development centers in the world. For the past two decades it has acquired an international reputation as a non-profit Product Development Partnership (PDP), advancing vaccines for poverty-related neglected tropical diseases (NTDs) and emerging infectious diseases of pandemic importance. One of their most notable achievements is the development of a vaccine technology leading to CORBEVAX, a traditional, recombinant protein-based COVID-19 vaccine.

"It's an honor to be recognized not only for our team's scientific efforts to develop and test low cost-effective vaccines for global health, but also for innovation in sustainable financing that goes beyond the traditional pharma business model," says Hotez in a statement.

The technology was created and engineered by Texas Children's Center for Vaccine Development specifically to combat the worldwide problem of vaccine access and availability. Biological E Limited (BE) developed, produced and tested CORBEVAX in India where over 60 million children have been vaccinated so far.

Earlier this year, the doctors were nominated for the 2022 Nobel Peace Prize for their research and vaccine development of the vaccine. Its low cost, ease of production and distribution, safety, and acceptance make it well suited for addressing global vaccine inequity.

"We appreciate the recognition of our efforts to begin the long road to 'decolonize' the vaccine development ecosystem and make it more equitable. We hope that CORBEVAX becomes one of a pipeline of new vaccines developed against many neglected and emerging infections that adversely affect global public health," says Bottazzi in the news release from Texas Children's.

Fast Company editors and writers research candidates for the list throughout the year, scouting every business sector, including technology, medicine, engineering, marketing, entertainment, design, and social good. You can see the complete list here

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