Ralph J. Damiano,
pioneers robotically assisted herat surgery
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Ralph J. Damiano, pioneers robotically assisted herat surgery |
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Merging clinical care,
research & education Ralph J. Damiano sits at the forefront of innovative heart surgery By Gila Z. Reckess Behind the desk of Ralph J. Damiano Jr., M.D., hangs one of his personal mottos: Leadership is action, not position.
According to Jennifer S. Lawton, M.D., a former research fellow of Damiano's and now an assistant professor of surgery, his motivation and perseverance are contagious. "Dr. Damiano has limitless energy and ideas," Lawton said. "He is an excellent administrative leader and a generous mentor, always putting his students' aspirations and goals above his own. "As residents, we used to say that if you could attach yourself to his coattails, only good things would happen." Though they share the same name, Damiano and his father had ironically different career interests. A multitalented entertainer by profession, the senior Damiano used to ask his son, "Ralph, why are you working so hard? Do you really like medicine that much?" The answer was always the same: Yes. "To be successful in life, you have to be passionate about what you're doing," said Damiano, who learned this lesson in part by watching his father build a livelihood from his talents. "I've been blessed with a career that I find just as exciting today as I did when I started." This lesson -- that life is too short to waste on something you don't truly enjoy -- is a message he now passes on to his medical students and interns. According to Sunil M. Prasad, M.D., Damiano's postdoctoral surgery fellow, "Damiano is the best mentor I could possibly imagine. He's far-sighted and very driven, and somehow he's able to put together being a great surgeon and an innovative researcher while still finding time for his family." Making time for all of life's important components is what Damiano believes is the secret behind his success at work and at home. Though he doesn't have time for rowing and volleyball and the other assorted sports he played in college, he, his wife -- Diane L. Damiano, Ph.D., associate professor of neurological surgery -- and their three children still play tennis, ski and travel together whenever possible. Finding the route toward a satisfying career was not difficult for Damiano. Not only did he always enjoy learning about the world through science, but also he was naturally good at it. As a muscular intercollegiate athlete and biology major, Damiano was asked to be a patient-sitter in his first year at Dartmouth College. In place of the fabric straps now used to restrain potentially violent patients, Damiano would sit during the night with patients whose diseases or medications made them a physical threat. This first exposure to the medical field immediately sparked his interest in clinical care. "I really felt like I was making a difference by spending time with these patients," Damiano said. "My innate interest in biology, coupled with how much I enjoyed the contact with patients and nursing staff, convinced me that I wanted to go into medicine." At Duke Medical School, Damiano discovered another natural talent -- surgery. On the third day of his surgery rotation, a resident informed him that the chairman of the department, David C. Sabiston Jr., M.D., specifically requested a commitment from the young Damiano to pursue a surgical specialty. "Surgery matched my personality perfectly," Damiano explained. "I love doing things with my hands, and the instant results in surgery are fantastic. You really can make a difference in a lot of people's lives."
Cox's innovative spirit inspired Damiano's future career. At the Medical College of Virginia, Damiano began researching ways to protect the heart. New substances developed in his laboratory now extend the amount of time the heart can be preserved and also improve surgeons' ability to safely stop the heart during surgery. After seven years in Virginia, Damiano was recruited to Pennsylvania State University as chief of cardiothoracic surgery. There, his interest in protecting the heart during surgery took an interesting turn. Beyond continuing to develop preservation solutions, Damiano also began devising ways to make cardiac surgery less invasive. To perform a heart bypass, surgeons replace a clogged or diseased artery with a healthy blood vessel from another part of the body. The most dangerous aspect of this procedure is the temporary cessation of the heart required to perform this delicate surgery. This requires using a heart-lung machine to support the patients' circulation while the heart is stopped. Damiano's team first began using methods to perform surgery on a beating heart: He stopped the motion of a small section of heart tissue by suctioning it between two prongs, allowing the remainder of the heart to function normally. The second hurdle for making heart surgery less invasive is eliminating the 12- to 18-inch incision in the chest, which is one of the main sources of postoperative pain. Surgeons in other fields use small endoscopic tools to perform surgery through pencil-sized holes in the skin. But these devices are more than three times as long as traditional instruments and present several challenges to heart surgeons. "Imagine trying to sign your name with a 12- to 18-inch pen," Damiano explained. "You can do it, but your handwriting would probably be illegible." Moreover, endoscopic instruments are inserted through the chest wall, which is a fixed pivot point. As you move your hand to the right, the instrument tip deflects in the opposite direction. This fulcrum effect is counterintuitive and disorienting. With so many obstacles, he quickly realized that endoscopic tools were not feasible for cutting and suturing vessels the size of spaghetti. That's where robots come in. When performing robotically assisted heart surgery, the surgeon sits near the patient at a computer console, which consists of a video monitor, a computer control system and two instrument handles. The two handles allow the surgeon to perform the same movements he does during traditional heart surgery. However, these movements are relayed mechanically to a computer, which rescales the motions, filters out hand tremors and relays the digitally perfected movements to two robotic arms on the operating table, each of which holds specialized endoscopic instruments. Simple voice commands control a robotic arm that holds a video camera, also inserted endoscopically. Damiano used the Zeus Robotic Surgical System, produced by Computer Motion Inc. of Goleta, Calif., to perform the first robotically assisted bypass graft in the United States in December 1998. Shortly thereafter, in April 2000, Damiano joined the School of Medicine, where he continues to pioneer the use of robotics and researches ways to improve the technology, in association with the Department of Biomedical Engineering in the School of Engineering and Applied Science. "We are indeed fortunate to have Dr. Damiano as the chief of our cardiac surgical service," said Joel D. Cooper, M.D., the Evarts A. Graham Professor of Surgery and Head of the Division of Cardiothoracic Surgery. "He is exuberant, inquisitive and very innovative, which helps make our division an exciting place to work." Besides decreasing pain and recovery time for heart surgery patients, robots may someday allow aspiring surgeons to simulate real, robotically assisted surgery rather than relying on the traditional trial and error method. "We have three basic missions at Washington University: clinical care, research and education," Damiano said. "Robotics merges all of those together, which is very gratifying." According to Damiano, the opportunity to synthesize these three goals is made possible by the unique combination of clinical, academic and basic science excellence at the University. "The School of Medicine is a rare place that allows its faculty to combine a vibrant clinical practice with a world-class research environment," he said. "That combination is critical for me because, while I really enjoy research, the most rewarding aspect of my job is that I can use my research to directly improve people's lives as a surgeon." |
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