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August 10, 2005

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Palo Alto Online

Publication Date: Wednesday, August 10, 2005

He's got the 'touch' He's got the 'touch' (August 10, 2005)

Palo Alto surgeon at forefront of revolutionary heart procedure

by Chuan-Mei Lee

After seven long hours in the waiting room at the California Pacific Medical Center, Andrew and Jill Tulloch finally breathed a sigh of relief. The life-saving operation to correct their newborn son William's congenital heart condition had been a success.

"[William] was totally a different color because his circulation had been fixed," said Jill Tullock. "He had blue fingers, and all of the sudden he was pink."

William's operation involved minimally-invasive surgical techniques pioneered by his surgeon, Dr. Michael Black of Palo Alto. Black was able to re-wire arteries in William's tiny heart without placing a finger inside William's body. Thanks to Black's advanced "touch-free" procedure, William will be recovering sooner -- and with a smaller scar.

What makes Black's "touch-free" operations special? While traditional heart surgery requires a large incision stretching from collarbone to bellybutton, Black routinely operates through a much smaller incision, regardless of the type of heart procedure or size of the patient. He uses thin, fiber-optic cameras to visualize the heart and employs long, slender surgical instruments to perform delicate maneuvers, allowing his gloved hands to remain outside the patient's body.

In some cases, he's even able to use a robot to help him reach deep into the chest.

Conventional wisdom dictates that a larger incision makes for a safer operation because more area is visible. But Black believes this philosophy is outdated.

"Using cameras, you see as much as you need to see," Black said. "And I've never had to make an incision bigger because I've run into a problem."

Because of a smaller incision, Black said his patients tend to experience a faster recovery, less physical discomfort, a lower risk of infection, and less physical disfigurement. Additionally, Black maintains that overall death rates have been lower because of fewer complications.

"I've done hundreds of minimally-invasive procedures," Black said. "I realized that you don't have to open the entire bone, or you don't have to make these really big incisions. [Patients] don't require as much pain medication. They can eat earlier. They don't have as much lung collapse. They just recover so much faster."

Despite the benefits of minimally-invasive heart surgery, Black admits that few other surgeons are performing similar procedures. He says it has to do with an individual surgeon's willingness to learn new techniques.

"I think it comes down to personality," Black said. "It is a teachable technique, and I think it can be adopted, but the person has to have an immense amount of patience in the beginning."

To work with smaller surgical openings, a physician would have to adopt a new set of surgical skills and accept new technology.

"I think when a lot of new technology comes out people don't embrace it because they want to wait for the second generation," Black said. "I'm not a strong believer in waiting. I'm really a techno-geek. I took the tape off my glasses, but I love technology."

Black began experimenting with new technology for heart operations a decade ago. Initially, he took a tiny camera made for knee surgeries and used it to peer into the heart. Through these experiences, Black taught himself the techniques he uses today to treat hundreds of children and adults with congenital heart defects.

"People thought I was crazy," Black said. "They said, 'What are you doing?' I soon learned that by making very small incisions and by using a camera to magnify and illuminate what I was seeing, it was truly beneficial."

Black is constantly pursuing new ways to peer into the chest cavity. He's currently trying to invent a camera that can see through blood. He envisions a future in which doctors can peer through transparent blood and weld together body tissue.

Despite his love of technology, Black said his love for patient interaction comes first. Black keeps in touch with many of his former patients. One woman, who is now getting married, recently sent him an e-mail with a picture of herself in a strapless wedding gown. The tip of the scar from her heart surgery was barely visible.

"I love the interaction," Black said. "I really feel satisfied that I get to do this as a line of work. It's more than just a job."

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