Overview

Robotic Heart surgery

Robotic surgery is a technique in which a surgeon performs surgery using a computer that remotely controls very small instruments attached to a robot.

Robotically-assisted heart surgery is the latest advance in trying to move open heart surgical procedures to the category of minimally invasive surgery - that is, to minimize the extent and the trauma of cardiac surgery as much as possible. Most minimally invasive surgery is performed by passing an endoscope (a small tube containing an advanced optical system) through a tiny incision. Surgical instruments are then passed either through the endoscope tube itself, or through an additional tiny incision. While visualizing the surgical area through the endoscope, the surgeon manipulates the surgical instruments to complete the operation.


How is robotic heart surgery being used?

Much of the early work with robotically-assisted heart surgery has been with bypass surgery. So far, this technique has been limited to single bypass grafts in the left anterior descending coronary artery (the LAD). The LAD is located on the front of the heart, and therefore is relatively accessible. It is predicted that with advances in technology, multiple grafts with robotic assistance will be possible, at virtually any location on the heart.

Early efforts have been made at extending robotically assisted surgery to other kinds of heart surgery. Robotic procedures have been successfully performed, for instance, in mitral valve repair, in repairing atrial septal defects (ASD,) and in repairing patent ductus arteriosus (PDA.) It is expected that as experience and technology advance, robotic procedures will be applied to most other forms of heart surgery.

Description :

This procedure is done under general anesthesia (you are asleep and pain-free). The surgeon sits at a computer station nearby and directs the movements of a robot. Small instruments are attached to the robot's arms.

The surgeon first inserts these instruments into your body through small surgical cuts. Under the surgeon’s direction, the robot matches the doctor’s hand movements to perform the procedure using the tiny instruments.

Doing a job well means using the most appropriate tools available, and surgery is no exception. Today, with the new Da Vinci Heart Surgery Surgical System, Spectrum Health surgeons have an innovative tool—a robotic assistance system—that brings a new level of precision to many common surgeries. For patients, that means less pain, less blood loss, less scarring, shorter recovery times and a faster return to normal, daily activities.

da Vinci heart surgery is an alternative to conventional open heart surgery – the traditional way to treat mitral valve disease. da Vinci Robotic heart surgery is performed using the da Vinci Surgical System, enabling your surgeon to operate with unparalleled precision and control through a few small incisions.

Spectrum Health became the first in West Michigan to purchase the da Vinci system two years ago. Since that time, the equipment—which consists of a surgeon’s console, a patient-side cart, a high-performance vision system and proprietary instruments—has been used for hundreds of procedures. These include prostate surgery and other urological procedures; thoracic surgeries on the esophagus, lungs and thymus; and some aspects of cardiac surgery, including placing pacemaker leads.


Why The Procedure Is Performed

Robotic surgery is a type of procedure that is similar to laparoscopic surgery. It also can be performed through smaller surgical cuts than traditional open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques.

Sometimes robotic-assisted laparoscopy can allow a surgeon to perform a less-invasive procedure that was once only possible with more invasive open surgery. Once it is placed in the abdomen, a robotic arm is easier for the surgeon to use than the instruments in endoscopic surgery.

The robot reduces the surgeon’s movements (for example, moving 1/2 inch for every 1 inch the surgeon moves), which reduces some of the hand tremors and movements that might otherwise make the surgery less precise. Also, robotic instruments can access hard-to-reach areas of your body more easily through smaller incisions compared to traditional open and laparoscopic surgery.

During robotic surgery, the surgeon can more easily see the area being operated on. The surgeon is also in a much more comfortable position and can move in a more natural way than during endoscopy. However, robotic surgery can take longer to perform, due to the amount of time required to set up the robot. In addition, the robot is expensive to use and may not be available in many hospitals.


Robotic surgery may be used for a number of different procedures, including:

Coronary artery bypass
Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs
Gallbladder removal
Hip replacement
Hysterectomy
Kidney removal
Kidney transplant
Mitral valve repair
Pyeloplasty (surgery to correct ureteropelvic junction obstruction)
Pyloroplasty
Radical prostatectomy
Tubal ligation

Robotic surgery cannot be used for some complex procedures. For example, it is not appropriate for certain types of heart surgery that require greater ability to manipulate instruments in the patient’s chest.

Risks :

The risks for any anesthesia are:

Reactions to medications
Problems breathing

The risks for any surgery are:

Blood clots in the legs that may travel to the lungs
Breathing problems
Heart attack or stroke
Infection, including in the lungs, urinary tract, and chest
Blood loss
Infection

Before The Procedure :

You cannot have any food or fluid for 8 hours before the surgery. If you are having certain types of abdominal surgery, your surgeon may recommend that you cleanse your bowels with an enema or laxative the day before surgery.

Stop taking aspirin, blood thinners such as warfarin (Coumadin) or Plavix, anti-inflammatory medications, vitamins, or other supplements 10 days before the procedure. After The Procedure

You will be taken to a recovery room after the procedure. Depending on the type of surgery performed, you may have to stay in the hospital overnight or for a couple of days.

You should be able to walk within a day after the procedure, depending on what type of procedure was done. Avoid heavy lifting or straining until your doctor gives you the okay. Your doctor may advise you not to drive for at least a week.


What are the advantages of robotic heart surgery?

The chief advantage of such surgery is that the incisions that are made are tiny, and therefore recovery from surgery is extremely quick. Rapid recovery from cardiac surgery is not only better for the patient, but it is less expensive for society.


What are the disadvantages of robotic heart surgery?

The chief disadvantage at this point is that the technology is new, and (despite early encouraging reports) is still evolving. Its efficacy and safety have not yet been proven sufficiently to allow the FDA to approve it for widespread use.

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