Ralph J. Damiano Jr., M.D.

DEPARTMENT OF Surgery
Keywords: surgical ischemia, robotics, surgery

Surgical robotics laboratory. Our research team has pioneeered the use of robotics in surgery. We have performed the first robotically-assisted operation in North America and are dedicated to applying the latest in robotics and computer technology to the development of minimally invasive and endoscopic cardiac surgery.

The goal of the Surgical Robotics Laboratory is to both develop and evaluate cutting-edge technology and new surgical techniques in the new field of computer-assisted surgery. Our objective is to be the world leader in this novel area through a cooperative interdisciplinary effort with the Washington University Institute of Minimally Invasive Surgery and the Department of Engineering at Washington University. The driving vision of our laboratory is that the integration of computers and robotics into the operating room will have a revolutionary impact on surgery and usher in a new era of minimally invasive cardiac procedures, opening an entire new world of possibilities to surgeons through the enhancement of our surgical dexterity, digital enhancement of our video images, and the use of novel computer guidance and data fusion technologies. This will be done by a cooperative effort between surgeons, engineers and industry. Our present projects include:

1) Study of endoscopic, beating heart surgical techniques
2) The use of novel technology to develop minimally invasive treatments for arrhythmias (including atrial fibrillation)
3) The investigation of alternative bypass conduits and novel ways of myocardial revascularization
4) The investigation of computer control systems
5) Evaluation of the most appropriate methods of digital motion manipulation
6) The use of novel magnetic guidance systems to position cameras and instruments in confined spaces
7) An intensive investigation is underway to evaluate the best way to train surgeons in robotic and endoscopic techniques. Our training facility is evaluating novel approaches to resident and surgeon education. Our main goal is to define optimal educational techniques and to define objective parameters to define skill development. This work is done with a multidisciplinary team, including Dr. Mary Klingensmith in the Division of General Surgery.

Physiology of surgical ischemia laboratory. The long-term objective of this laboratory is to investigate the pathophysiology of surgical ischemia occuring during traditional cardiac surgery and transplant preservation. The goal of this laboratory is to exploit basic electrophysiologic and cellular mechanisms to improve myocardial protection during elective cardiac arrest and organ preservation during cardiac transplantation. A particular interest of our laboratory has been the use of hyperpolarizing agents to arrest the heart at its normal resting membrane potential. Our basic hypothesis is that the arrest of the heart at its normal resting membrane potential, the cells' natural resting place, will improve the protection of the heart during periods of stress. We also are involved with a thorough investigation of cell volume regulation and its role in the generation of myocardial stunning. We study the physiology of surgical ischemia in a variety of settings, from isolated myocytes, transgenic animals, isolated Langendorf heart prepartions, and both small and large animals. Current projects include:

1) The physiology of hyperpolarized arrest during cardiac surgery
2) Cell volume regulation during cardioplegic arrest
3) Cellular mechanisms of volume regulation and its interaction with myocardial stunning
4) Relationship between cell volume and myocardial function
5) The role of ion fluxes in the cell response to cardioplegia
6) The relationship between post-operative arrhythmias and myocardial protection
7) The pathophysiology of post-operative atrial fibrillation
8) The investigation of novel organ preservation solutions