ROBOTIC CARDIAC SURGERY A GUIDE FOR PATIENTS

What is Robotic Heart Surgery?

Robotic heart surgery has revolutionized the way we think of heart operations. When you think of heart surgery, a large scar down the entire front of the chest comes to mind. Robotic cardiac surgery is heart surgery done through very small cuts in the chest. With the use of tiny instruments and robot-controlled tools, surgeons are able to do heart surgery in a way that is much less invasive than open-heart surgery. The procedure is sometimes called da Vinci surgery because that is the name of the manufacturer of the robot often used for this procedure.

Robotic surgeries have been used for a number of different heart-related procedures, including valve surgery, coronary artery bypass, cardiac tissue ablation, heart defect repair, and tumor removal.

How Does a Heart Surgeon Use the Robot?

Unlike conventional surgery, robotic heart surgery is performed by a heart surgeon who uses a console that is not directly next to the patient, but is somewhere else in the room. The surgeon sits at the console and the robot is positioned over the patient. The surgeon controls the robot from the console by using 2 master handles. Through the console the surgeon is able to see high resolution, three dimensional and magnified views. This allows robotic heart surgery with a high precision of movement and placement of micro-sutures, through a tiny incision.

Development of Robotic Heart Surgery

Heart operations were almost all done through large incisions in the chest wall and over the years a number of techniques were devised to allow smaller and smaller incisions known as minimally invasive heart surgery. Robotic heart surgery takes minimally invasive heart surgery to a whole new level. The most commonly used system is the FDA approved ‘da Vinci’ system. Robotic heart surgery allows for operations to be done through relatively tiny holes and can recreate the tiny delicate of movements.

Procedures Done Using Robotic Heart Surgery

  • Coronary Artery Bypass Grafting – Bypass surgery is an operation used to treat blockages in the heart arteries. In certain cases this can be done using a robotic approach. Sometimes when there are a number of blockages, and a robotic approach is still preferred, then a combination of robotic surgery and stents can be used. The main advantage of bypass surgery is when a bypass is done on the Widowmaker artery on the front of the heart known as the left anterior descending artery. In a hybrid procedure, the bypass can be done to that artery and the other arteries treated with stents as required.
  • Robotic Mitral Valve Surgery – This is the claim to fame of robotic heart surgery and where it has been most successfully applied. This can be for a leaky heart valve called mitral regurgitation or a tight heart valve called mitral stenosis. Expert surgeons can perform both mitral valve replacements and complex mitral valve repairs. Studies have shown that when performed by expert surgeons, the results are excellent. Mitral valve surgery is the most commonly performed robotic heart surgery.
  • Robotic Tricuspid Valve Surgery – Tricuspid valve surgery can be successfully performed using the robot. This is most commonly for a leaky tricuspid valve known as tricuspid regurgitation. This surgery can be performed in a timely fashion with good results.
  • Robotic Atrial Septal Defect Surgery – Atrial Septal Defects are holes between the upper chambers of the heart and people are usually born with these. These are typically closed using catheter-based techniques through the vessels of the leg. In some cases this cannot be done with catheters and robotic surgery can provide a good next minimally invasive option.
  • Robotic Atrial Fibrillation Surgery – A number of techniques can be used to treat atrial fibrillation with heart surgery and these have been extended by some expert surgeons to treating with use of the robot.

 

Who is a Candidate for Robotic Heart Surgery?

Anyone with mitral valve disease is a potential candidate for a robotic mitral valve operation and we consider anyone who comes in with mitral valve disease a robotic heart surgery candidate until we prove otherwise. We then look closely at each patient and see if there are any reasons that we cannot accomplish it.

Things that often mean robotic heart surgery is not possible include prior heart surgery on the right chest. Diseased arteries of the legs. There are some other technical issues that make protection of the heart difficult during robotic heart surgery. Commonly the need for other procedures at the same time rule out robotic heart surgery, such as the need to perform coronary artery bypass grafting or aortic valve replacement at the same time. Prior heart surgery or prior mitral valve surgery typically does not exclude patients from having robotic heart surgery.

What is the Recovery Time After Robotic Heart Surgery?

We define recovery as a return to normal activities. A traditional sternal incision is 2 months, with no driving for a month and no heavy lifting for at least 2 months. With a robotic surgery, it is typically only 2 weeks, so significantly shorter. Of course patients prefer this. A faster recovery and a less traumatic incision are the key factors that make robotic heart surgery the preferable option for many patients.

What are the risks of robotic cardiac surgery?

One of the main benefits of robotic cardiac surgery is that it has fewer risks than open-heart surgery. The surgeon does not have to cut through the breastbone to open your chest. This removes many of the complications of open-heart surgery.

Robotic cardiac surgery still requires anesthesia and, as with any kind of surgery, there are always risks involved, including:

  • Heart attack
  • Stroke
  • Infection
  • Death
  • In some cases, your doctor may not be able to complete the surgery with the robot. In this case, you would need open-heart surgery.

You may have other risks, based on your specific medical condition. Be sure to talk with your healthcare provider about any concerns you have before your procedure.

Advantages of Robotic Heart Surgery for Patients

The most obvious advantage of robotic heart surgery is the fact that there is no large scar on the chest since the procedure is performed through small incisions. Not only can this offer a cosmetic advantage but also decreased trauma, and less post-operative pain. There is a possibility of decreased need for blood transfusions, a decreased stay in the intensive care unit, decreased length of stay in the hospital, and a more rapid recovery with return to work. In the right hands, robotic heart surgery can lead to a smaller incision, less pain, shorter hospital stay, and a faster return to work.