Info on Robotic Cardiac Surgery Procedures

Quick Links

Totally Endoscopic Robotic Mitral Valve Surgery
Robotic Coronary Artery Bypass
Surgery for Atrial Fibrillation
Other Procedures

Totally Endoscopic Robotic Mitral Valve Surgery

The robot is particular helpful for repairing the mitral valve because of its location in the heart.  Five small incisions are made under the armpit usually ranging from 7-20mm in size (for repair).  The real advantage of this over traditional sternotomy (breast plate division) or “port access” approaches (5-10 cm”mini” right thoracotomy) is that incisions are very small and rib spreading is not needed.  Rib spreading causes pain.

Example of Totally Endoscopic Robotic Mitral Valve Repair Incisions by Dr. Guy

If replacement is required, a 30cm incision (with a 35mm port) is often necessary to allow us to get the new valve into the chest but there is no rib spreading.

The surgeon can see the valve very well as can all team members participating in the surgery (by looking at TV screens in the OR).  In standard surgery, usually only the surgeon can get a reasonable view.  I think it is easier to expose the valve and see all of it than with traditional approaches.  Performing totally endoscopic mitral valve surgery with the robot requires the use of advanced techniques for heart-lung bypass and stopping the heart.  In traditional surgery, the heart is bypassed and stopped during surgery using tubes (cannulas) placed directly in the heart.  With our endoscopic robotic approach, this is usually done through blood vessels to the leg (femoral artery and vein) using catheter-based approaches and a small incision.  One additional difference between totally endoscopic robotic mitral valve surgery and other techniques is that it requires much more teamwork in the operating room than most programs can muster.  The era of the “superstar” surgeon is over and the era of the “superstar” surgical team has arrived!

Totally Endoscopic Robotic Repair Surgical Ports

The robot can also be used to replace the mitral valve.  Other procedures can be done at the same time including tumor removal, closure of the atrial appendage, MAZE procedure for atrial fibrillation, tricuspid valve repair or replacement, and others.  Patients with HOCM (Hypertropic Obstructive Cardiomopathy) can also undergo resection of the abnormal muscle blocking flow and repair of the mitral valve with the endoscopic robotic technique.

Request an appointment with Dr. T. Sloane Guy to discuss robotic mitral valve surgery.

Below is a video of a robotic totally endoscopic mitral valve repair performed by Dr. Guy.

Totally Endoscopic Mitral Valve Replacement

Totally Endoscopic Robotic Mitral Valve Replacement Ports

We generally repair mitral valves in most cases.  However, some patient still require replacement and this can be done endoscopically with the robot by Dr. Guy and the team at Temple.  The “working port” is slightly larger at 35mm (compared to 15mm in repairs) in order to fit the prosthetic valve into the chest (tissue or mechanical).  A 30mm incision is made to place this port.  There is absolutely no rib spreading involved (rib spreading done in other methods often causes pain).

Below is a video of a robotic, totally endoscopic mitral valve replacement performed at Temple.

Totally Endoscopic Coronary Artery Bypass (TECAB)

The robot can be used to bypass blocked or narrowed coronary arteries.  Our favored approach is to use the robotic to perform the entire bypass procedure.  The TECAB operation involves only small incisions (7-15mm) and is totally endoscopic.  The internal mammary artery on the chest wall is detached from the chest and the anastomosis (connection between the mammary artery to the blocked coronary artery to bring new blood to it) is done with the robotic instruments by the surgeon at the console.  We usually use suture for this exactly the same way that would be done with traditional approaches.  Due to the need for extensive training, experience, high-level teamwork, and major institutional support, the TECAB is performed by a relatively small number of surgical teams in the country.  We have all of the above at Temple University.
Request an appointment with Dr. T. Sloane Guy to discuss robotic coronary artery bypass surgery.

Surgery for Atrial Fibrillation

Robotic Cryomaze Procedure Cartoon

Using techniques similar to that of the mitral valve, a “MAZE” procedure can be performed to treat atrial fibrillation either alone or with a mitral valve operation.  This can be done many different ways, but I prefer a totally endoscopic cryomaze approach using the ATS® (now owned by Medtronic, Inc.®) cryoprobe.  This approach and technology reproduces the important lesions originally descibed by Dr. Cox who designed the procedure upon which all atrial fibrillation procedures (both catheter and surgery) are based upon.  I believe that this gives you the best chance of being successfully put into sinus rhythm short of the original “cut and sew” method that requires a sternotomy (breast plate division).

Request an appointment with Dr. T. Sloane Guy to discuss surgery for atrial fibrillation.

Other Procedures

The tricuspid valve can be approached very similarly to the mitral valve. It can be repaired or replaced through small incisions in the right chest with or without other procedures such as mitral valve surgery.  Tumors in the right or left atria or the ventricles can be removed robotically. The most common example of this would be an atrial myxoma.  Atrial septal defects are particularly easy to fix with the robotic approach.  Again, these are done through small incisions under the right armpit lateral to the breast.

Request an appointment with Dr. T. Sloane Guy to discuss other robotic heart surgery procedures.