With robotic surgery, patients experience less pain and trauma and a quicker recovery time.
Health News
It’s Robo-Surgeon!

Vaughn Starnes and a robot named “da Vinci” perform mitral valve repair, in a process he calls “truly the next advance in heart surgery.”

SURGEONS RECENTLY pulled off a Southern California first – the regional debut of robotic heart repair. On April 27, a team of cardiothoracic surgeons led by Vaughn Starnes fixed the mitral valve of patient Lotte Henderson using the “da Vinci” Surgical System.
“Robotic surgery is going to revolutionize cardiothoracic procedures,” says Starnes, who made medical history in 1993 after performing the world’s first double-lobar lung transplant from living, related donors. “This is truly the next advance in heart surgery.”
The da Vinci system allowed Starnes to operate remotely, using controls on a computer console. Surgical instruments were inserted through small holes in the patient’s side. Traditional mitral valve surgery involves a long incision, and surgeons must split the breastbone to reach the heart. Even using advanced techniques, the incision can be4 inches long. But through the small punctures and tiny instruments involved in robotic surgery, patients experience shorter incisions, less pain and trauma and a quicker recovery time.


DURING THE PROCEDURE at USC University Hospital, Starnes sat at a console about 8 feet away from the patient, while a three-armed, 1,000-pound robot was positioned beside her. Starnes grasped and moved highly sensitive instruments at the console while viewing Henderson’s heart – greatly magnified – on a screen. The robot precisely matched Starnes’ natural hand and wrist movements, translating them to the tiny instruments placed inside the patient through small puncture incisions. So deft is da Vinci’s touch that it can place sutures the thickness of a human hair.
In Henderson’s case, the minimally invasive procedure required three small incisions between the ribs, two for the insertion of interchangeable instruments and another for a thin, cylindrical video camera, called an endoscope. Starnes shaped and sutured tissue into place, shortening a cord (a sort of “heart string”) that supports the heart valve. He also stitched in a shoelace-like ring to brace the valve.
Though the robot operated silently, it created quite a buzz in the hallway outside the operating room, where other surgeons, physicians and nurses

USC surgeons adjust the da Vinci robot arm. The machine allows surgeons to operate remotely, using minimally invasive technology.
crowded around a monitor to watch the procedure. Some peered through operating room windows to try to get a better look.
“Mitral valve repairs technically are among those requiring the most skill from a surgeon,” says Daniel Schwartz, a Keck School of Medicine surgeon who assisted in the procedure. “This is a procedure not many people across the country do, even without a robot.”
Starnes notes that the robot is a spin-off of defense technology. The California-based company Intuitive Surgical developed the da Vinci system at the urging of the Pentagon, which was seeking a way for military surgeons to perform operations remotely on the front lines or at sea. USC is one of several sites in a Food and Drug Administration-approved trial to evaluate the use of da Vinci to repair the heart’s mitral valve.

– Alicia Di Rado

Race and obesity
A Metabolic Mystery

For science-minded schoolgirls, summer fun means flirting with Catalina’s cutest locals – crabs, algae, seaweed and plankton.

Obesity is increasing across all ethnicities in the United States – up some 60 percent since 1990 – but statistically more African Americans (27 percent) are obese than whites (18 percent). Why? USC researcher Michael Goran has shed some new light to the metabolic mystery. Goran, a professor in the Keck School of Medicine, recently analyzed data from a longitudinal study of schoolchildren in Alabama. For seven years, Goran and his colleague have followed the cohort of 92 white and 64 African-American children.
During childhood there had been no difference in the kids’ metabolisms, but toward the end of puberty the black children began to show a slower resting energy expenditure – meaning they burned fewer calories while at rest. (The study also showed that by age 10, 38 percent of the African-American girls were overweight.) The findings appeared in a recent issue of the American Journal of Clinical Nutrition.
Intriguing as this is, Goran maintains that the slower rates of resting metabolisms do not necessarily correlate with fat gain, since metabolism is determined by body lean mass (organs and muscle mass) and doesn’t vary much from day to day. “If you have more muscle, you’ll have a higher metabolic rate. If you have less, you have a lower metabolic rate,” Goran says. “It’s like saying Shaquille O’Neal, who has a lot of muscle, has a high metabolic rate. That doesn’t mean he won’t become obese if he stops exercising and starts eating a lot.”
Other environmental factors like caloric intake and physical activity levels may be more significant when it comes to obesity, Goran believes. “We know from earlier studies that black kids have a lower level of fitness to begin with, and a lower level of fitness is a risk factor for fat gain,” he says. “That’s something that may be contributing to the greater obesity among African Americans.”
For many years, the public has been told that a low metabolism rate leads to weight gain. “We’re simply not finding that in our research,” says Goran. “It’s an important message, and one people might not want to hear. It’s much easier to attribute weight gain to your metabolism, because there’s nothing you can do about your metabolism. But you can change the amount you eat and the amount you exercise and these changes may have important benefits.”

– Monika Guttman

Giving Birth with a Bum Ticker
In a Delicate Condition

Obstetricians have long recognized that women with diseased heart valves seem to have difficult pregnancies, but until now no one had measured the risks to mother or baby. USC physicians recently completed the most extensive study to date on pregnant women with valvular heart disease.
Principal USC researcher Uri Elkayam led an interdisciplinary team of Keck School of Medicine cardiologists and obstetricians who looked at 66 pregnancies in women with valvular disease, comparing them to another 66 pregnant women with healthy hearts. The women with moderate to severe valve trouble, they found, were more likely to experience congestive heart failure and arrhythmias, and more likely to need to begin taking heart medications (or increase their dosage) or be hospitalized during pregnancy. Fetal health was also adversely affected. Women with heart disease were more likely to deliver babies prematurely, and even with full-term pregnancies were likelier to have low-birth-weight babies or babies that hadn’t developed properly in the womb. The researchers went on to meticulously measure the effects of pregnancy on different kinds of valvular heart disease – mitral, aortic and pulmonic stenosis – at varying degrees of severity. Ideally, they conclude in an article for the Journal of the American College of Cardiology, women with severe valvular stenosis should consider having it repaired before becoming pregnant. Failing that, they recommend close maternal follow-up and fetal surveillance in pregnant patients with moderate or severe aortic or mitral stenosis

– Bob Calverley
Mme. Guillotine’s Lovers

Adding fuel to the journalistic-ethics firestorm leading up to Timothy McVeigh’s June 11 execution, public radio producers announced they would air tapes of past public executions. Critics called it twisted, but USC communications scholar Martin Kaplan called it only human nature. “The truth is that throughout history executions have been used as public entertainment,” Kaplan said in a May 2 interview on PRI’s “Marketplace.” “Certainly the [battles of] gladiators were a kind of execution. In the 18th century, Samuel Pepys and James Boswell reported in their journals about going to public executions in London. The upstairs rooms of public houses … overlooking the gallows were rented out for a year’s income in order for spectators to watch.”
Illustration by John Cuneo / Photo by Michele A.H. Smith / Surgery Photo by Alicia Di Rado/ TV Illustration by A.J. Garces