Nifong participates in about two robotic valve repairs a week, often in conjunction with training sessions for other heart surgeons. In any given week there’s usually at least one U.S. or international surgical team in training at ECU’s Minimally Invasive and Robotic Training Center. The center is in the Edward N. Warren Life Sciences Building, an angular, glass-fronted building connected to the medical school by a vast breezeway looking over the nearby heart center.

Nifong leads training sessions at ECU and also travels to the surgeons’ home hospitals to oversee their first post-training valve procedures. Surgeons must complete a general cardiac training on da Vinci before they advance to valve training. The center also receives and transmits live broadcasts from the operating room via fiber optic cable and Internet connection.

A typical session takes two very intensive days that start in the operating room. Participants arrive in the OR at about 7:30 a.m. as the sedated patient is positioned at a 30-degree tilt, with the arm raised on a cushioned platform. Later, visiting surgeons watch as three small incisions, called ports, are made between the patient’s ribs on the right side and right breast for the pencil-sized camera and robotic arms to enter the heart.

During the operation, blood is routed to a heart-lung machine through a leg artery, where it is oxygenated before being returned to the body.

A palette of special instruments, some developed at the School of Medicine, help make this procedure possible. The Chitwood clamp, a long-handled instrument with a curved tip, stops the flow of blood into the heart at the aorta, the major blood supplier to the body.

“These instruments have to be angled a certain way so they don’t get in the way of the robotic arms. Plus, they have to reach into small areas,” said Penni J. Robinson, a research specialist at the surgery training center who’s also an ECU graduate (a master’s in nutrition ’99, focusing on biology, and a bachelor’s in cellular biology ’91). She manages the training schedule, prepares models and oversees the center’s day-to-day operation.

“With minimally invasive surgery, you have to adopt a laparoscopic frame of mind, using smaller tools and working at a computer monitor, as compared with the traditional ways, where everything is open and you use your hands,” she said. With da Vinci, “it’s exactly like having your own hands in that small space,” she said, adding that there are adjustments, such as learning to operate without tactile sensation.

In the afternoon, surgeons work on a fleshy plastic model resembling a heart, suturing the valve into place and reinforcing it with a polyester band. The second day, they may observe another operation or they may spend the day practicing on other models.

The center has developed life-like plastic models that reduce the need for cadavers or animal models, an effort Nifong piloted. When animal models are needed, surgeons can operate on pig hearts, obtained through agreements with area slaughterhouses.

“We’re able to take people through the training with inanimate objects,” said Nifong, an animal lover who once studied to become a veterinarian. “We’ve gone out of our way to lead others to do the same thing. To develop these models has taken a lot of work, but it’s important, and we’ve convinced others that there’s a need.”