Robotic Heart Surgery

In the June, 2001 issue of the Annals of Surgery, encouraging results have been reported from the first pilot study in the United States aimed at evaluating robotically-assisted coronary artery bypass surgery. One year after having the robotic bypass performed, all 19 patients included in the study remained free of complications and of angina.

What is robotic heart surgery?

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. Such endoscopic surgery works well for several types of operations (such as gallbladder removal and knee repairs,) where the part of the body to be operated upon is motionless, and the surgical maneuvers that need to be performed are relatively simple. But moving the surgical instruments manually during endoscopic surgery can be difficult – the length of the instruments is far longer than normal, and the “feel” of these long instruments is non-intuitive to the surgeon. Long instruments also exaggerate normal hand tremors. Thus, endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers tend to be complex. Robotically-assisted endoscopic heart surgery is aimed at making endoscopic heart operations feasible. With this technology, the surgeon manipulates the surgical instruments with the help of a computer. An endoscope is passed through a tiny incision in the chest wall, and two surgical instruments are passed through additional tiny incisions. The surgeon views the image provided by the endoscope on a computer screen. Instead of manipulating the surgical instruments directly, the surgeon manipulates them via a computer console – similar to manipulating a gamepad to play Ninetendo. The computer interprets the surgeon’s hand movements and causes the surgical instruments to respond accordingly. This system addresses the major disadvantages to moving the long surgical instruments manually – computer control of the surgical instruments essentially eliminates the tremor effect, and also the non-intuitive feel of maneuvering such instruments. While it takes special training to become adept at using robotically-assisted instruments, most surgeons who have had such training report that they feel quite comfortable maneuvering surgical instruments via a console instead of directly.

What are the advantages of robotic 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 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.

Reasons for the procedure

The main advantage of robotic cardiac surgery is that the procedure is minimally invasive compared with other forms of heart surgery. Smaller incisions mean that you can heal faster and return to activities more quickly. Your doctor may recommend robotic cardiac surgery if you need an artery bypass procedure to improve blood flow to the heart and reduce chest pain. Your doctor may also use robotic cardiac surgery to:

Repair or replace stiff or leaky heart valves to improve their function
Correct atrial fibrillation, a common type of arrhythmia
Remove a tumor in the heart
Treat congenital heart conditions
Your doctor may have other reasons to recommend robotic cardiac surgery.

Risks of the procedure

One of the main advantages of robotic cardiac surgery is that it minimizes many of the risks related to major heart surgery. The doctor does not have to cut through the breastbone to open your chest, so many of the complications involved with such a major surgery are eliminated. Robotic cardiac surgery still requires anesthesia before the procedure and, as with any kind of surgery, there are always risks involved, including:

Heart attack

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

During the procedure

As with any surgical procedure, your doctor will do a full assessment of your health to make sure you are a good candidate for robotic heart surgery. Factors including your age, medical history, and lifestyle, as well as the overall severity of the disease, will determine whether you are a good candidate for the procedure.

Before the Procedure

The following is the general sequence of events that will most likely occur during robotic cardiac surgery: You will be placed under general anesthesia for the surgical procedure. A surgeon will make a series of keyhole-sized incisions on the side of your chest. These incisions will align with the openings between your ribs. Depending on the procedure being performed, several precision-guided robotic arms will be inserted into these incisions. These robotic arms hold and manipulate tiny instruments in order to perform the required tasks on the heart or surrounding arteries. A tiny video camera will be inserted into another incision to provide a magnified, three-dimensional image of the operating site. The surgeon will control the robotic arms and camera from a special console located within the operating room. On completion of surgery, the surgeon will remove the instruments and close the incisions.


After the procedure

Once the robotic cardiac surgery is complete, you will be moved to the recovery area to be monitored. You can expect a relatively short hospital stay to follow, usually half as long as that following conventional open heart surgery. Your doctors will typically discharge you once your pain is under control, you can retain liquids without nausea and vomiting, and you pass a number of lab tests. The less invasive nature of robotic cardiac surgery also means that you can expect less scarring on your chest. Conventional heart surgery leaves a 10-inch scar on your chest. Robotic cardiac surgery just leaves a handful of smaller scars on the side of your chest. Postsurgical pain also tends to go away much faster than with traditional procedures.

After being discharged from the hospital, most patients can manage their pain with over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). You may also return to normal activities more quickly than you would after a conventional heart surgery. Most people can resume their normal activities after three weeks. Specific recommendations for activity will be provided by your doctor. Your doctor will typically schedule follow-up appointments after the procedure to check your progress. Be sure to notify your doctor immediately if any symptoms occur after the procedure, such as chest pain or discomfort. Complications are rare after robotic heart surgery, but possible, so it is important to carefully monitor for any symptoms and report them to your doctor.