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What is Robotic Heart Surgery All About?
Traditional heart surgery is usually done by dividing the breastplate with a saw (sternotomy). Robotic heart surgery allows surgeons to perform the same operations through tiny incisions. The reason is that robotic instruments have the same range of motion of a surgeon’s hands but are smaller than a dime. Robotic heart surgery requires a highly trained and experienced surgeon and team to perform.
With robotics, the surgeon sits at a console in the operating room controlling the instruments while looking at a 3D image from the camera inside the patient. The surgeon controls the robot at all times. It does not do anything without the surgeon directing it.
Many types of procedures can be performed with robotic assistance including: mitral valve repair or replacement, atrial septal defect closure, procedures to correct atrial fibrillation (MAZE), correction of HOCM (Hypertrophic Obstructive Cardiomyopathy), removal of cardiac tumors, tricuspid valve repair or replacement, coronary artery bypass surgery (TECAB or Totally Endoscopic Coronary Artery Bypass, robotic assisted MIDCAB or Minimally Invasive Direct Coronary Artery Bypass, hybrid procedures with robotic coronary bypass and coronary stents), pacemaker lead placement, and others.
The most important factor in selecting a center for robotic heart surgery is training and experience. Recent media reports have expressed appropriate concern over the safety of robotics by surgeons and teams that are inadequately trained and prepared for these advanced procedures. I have spent over a decade focused on the mastery of robotic surgery at every level and personally trained our team extensively. Many centers and surgeons claim to do robotic heart surgery, but very few are doing it routinely and through only tiny incisions. We mostly do what I consider to be totally endoscopic procedures, meaning that the incisions are so small (usually 8-15 mm) that you cannot see into the chest directly to do any portion of the procedure. Mitral valve replacement requires that we make a 30mm incision in order to get the new valve into the chest.
Many programs use the robot to do all or some parts of the surgery with larger rib spreading “mini-thoracotomies” through which the operation could easily be done without the robot. Unfortunately, these larger incisions can be even more painful than a sternotomy. Some make similar incisions and perform surgery without the robot.
Watch out for “drive by” robotic surgery and “bait and switch” marketing. Don’t be fooled by the word “robotic”.
“Drive by” robotics is what I would call doing surgery through a fairly standard incision but using the robot to do part of the operation. We see no advantage to this approach over standard non-robotic procedures. This is often done for marketing purposes so a program can advertise itself as doing “robotic heart surgery” and attract patients. Many programs use the robot to do the operation using “mini” thoracotomies through which the operation could easily be done without the robot. We believe this offers little advantage to the patient given the size of the incisions and associated pain. “Bait and switch” marketing is where a program or surgeon uses the robot to get you in his/her office and then signs you up for a non-robotic procedure when a robot could easily be used to do your procedure. Keep in mind, however, that most patients undergoing heart surgery need a standard incision depending on what their problem is. However, many heart surgery procedures are easily performed with the robot.
The purpose of this website is to provide you with detailed information and empower you so that you can make informed choices about your medical care. Ultimately the decisions are yours.
The incisions that we use for intracardiac surgery (mitral valve repair for instance) are extremely small. We do no rib-spreading which reduces pain. The cosmetic results are hard to match with any other technique. Most importantly, we perform the same operation that a typical surgeon does with larger, more painful incisions. We place a huge emphasis on not compromising the quality of the operation just to make a small incision. As you can see from the adjacent figures detailing the scars from a robotic mitral valve repair, this is truly a minimally invasive approach.
Patients who are large may actually benefit the most although the technique can be used in almost all body types. Patients with prior surgery also may benefit by from our approach by avoiding previous scar tissue from a prior sternotomy. Patients who have had prior surgery on the right chest may not be able to be done (some can) this way due to excessive scar tissue. Extensive evaluation and planning occurs prior to surgery, most notably with a 3D CT scan of the body from the chest down to the upper legs.