Who Is A Candidate For Robotically Assisted Heart Surgery
Diagnostic tests are performed to determine if you are an appropriate candidate for robotically-assisted surgery, including a cardiac catheterization and chest x-ray. An echocardiogram and/or a computed tomography scan also may be required to provide more information about your medical condition.
Your surgeon will review the results of these diagnostic tests to determine if you are an appropriate candidate for robotically-assisted surgery. The type of treatment recommended for your condition will depend on several factors, including the type and severity of heart disease, your age, medical history and lifestyle.
Robotic Heart Surgery Choosing The Right Place Is Critical
One of the most important aspects of undergoing robotic heart surgery is to have the surgery in a center where the number of cases being done is high, the experience level is high, and the results have been proven good. Robotic heart surgery is highly specialized and the learning curve is steep which means the results can be poor in the wrong hands. The good news is that the leading robotic centers have an infrastructure that is centered around robotic heart surgery and the outcomes are incredible. Centers of excellence for robotic mitral valve repair are a great example of this where repair rates may exceed those of conventional surgical centers. Probably the most important part of robotic heart surgery is having an experienced team.
What Are The Risks Of Robotic Heart Surgery
Like any surgery, a minimally invasive approach has some risks, most of which are also risks in traditional open-heart surgery. These can include complications such as bleeding, infection, stroke and arrhythmias, or an irregular heartbeat. In general, however, the risk of these complications is lower in a robot-assisted or minimally invasive surgery than in a traditional open-heart surgery. There is also a very small risk that complications during surgery will require a surgeon to change to an open-chest approach.
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What Advantages Does Robotic Heart Surgery Have Over Traditional Approaches
Traditional heart surgery requires surgeons to open up the chest to access the heart for repair. This approach requires cutting through the breast bone and opening up the rib cage, necessitating a very large incision and causing a lot of unintended damage to the chest.
With a robotic approach, surgeons dont have to cut through the breastbone. Instead, we slip instruments through small incisions between the ribs. This reduces the risk of post-surgical complications like infections and blood loss, dramatically reduces scarring, requires shorter hospital stays and allows for a much faster return to normal day-to-day activities. Patients also tend to experience much less pain during their recovery, because theyre not healing from a broken breastbone.
At the University of Chicago Medicine, some robotic heart surgeries are also performed without the use of a heart-lung bypass machine, thus reducing the risk of stroke and other neurological complications.
What Happens During Robotic Cardiac Surgery
The following is the general sequence of events that will most likely occur during robotic cardiac surgery:
- You may receive a sedative before the procedure to help you relax.
- You will be placed under general anesthesia for the procedure and you will have a breathing tube.
- 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.
- You may need to be placed on the heart-lung machine for the procedure.
- Depending on the procedure being done, your surgeon will insert several precision-guided robotic arms into these incisions.
- These robotic arms hold and manipulate tiny instruments to do 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 console located within the operating room.
- Once complete, the surgeon will remove the instruments and close the incisions.
Talk with your healthcare provider about what you will experience during your procedure.
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Why Choose Hackensack Meridian Health For Your Care
Hackensack University Medical Center is nationally ranked in the top 50 hospitals for Cardiology & Heart Surgery, and is the highest ranked hospital in the state of New Jersey, by U.S. News & World Report in 2022.
Jersey Shore University Medical Center, Hackensack University Medical Center and six additional hospitals in the network have ranked as High Performing by U.S. News & World Report in 2022 for heart failure.
The experienced teams at Hackensack University Medical Center and Jersey Shore University Medical Center performed more than 1,600 open heart surgery cases in 2020.
Myheartnet Special Feature On Robotic Heart Surgery
An Interview with Clifton Lewis MD, a world-renowned robotic heart surgeon who answers some commonly asked questions about robotic heart surgery. Dr Lewis has performed around 10,000 heart operations and incredibly almost 1000 robotic surgery cases. Dr Ahmed and Dr Lewis work together in the world leading Princeton Structural Heart and Valve Center in Birmingham Alabama where there are world class TAVR procedure, Mitraclip procedure and robotic heart surgery programs.
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Why Should I Consider This Procedure
Dr Bassin will recommend this procedure to patients who he thinks are suitable candidates. If you are deemed a good candidate you will be able to benefit from having heart or lung surgery without the pain and trauma usually associated with such major surgery. This will enable you to return to your everyday life, family, work commitments and other interests as soon as possible.
Robotic Mitral Valve Repair/ Replacement
Robotic surgery is available for mitral valve repair or replacement in patients with mitral valve disease. The most important aspect of mitral valve repair surgery is the quality and durability of the repair. The robot enhances visualisation and control for the surgeon to help achieve the best surgical outcome. The other main advantage of robotic surgery is that the operation is performed minimally invasively without needing to split the breastbone through 4 or 5 keyhole incisions. This enhances recovery, reduces pain and improves the cosmetic outcome.
Dr Bassin will discuss with each patient whether they are suitable candidates for safe and effective robotic mitral valve surgery. There are many factors that determine their suitability such as: cardiac function, additional heart valve conditions and previous vascular disease. Dr Bassin will take these factors into account for each individual patient, since the main priority is achieving an optimal mitral valve repair.
Robotic mitral valve repair or replacement is performed through 4 or 5 keyhole incisions for the robotic arms to access the heart. A separate incision in the leg connects the patient to the heart-lung machine during the surgery.
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What Is The Recovery Like
The recovery after robotic heart and lung surgery is far more rapid than traditional surgery. This is due to much smaller incisions, less trauma and less blood loss, which results in less pain and inflammation which are common barriers to a smooth recovery. The trauma of open surgery cant be underestimated and that is why recovery can usually take so long.
Following robotic heart surgery, you will wake up in intensive care later the same day. Small tubes to drain any residual fluid from around the heart will be placed in your neck, as well as intravenous lines, to sample blood and administer medications. These tubes and lines will be removed after 1-2 days and then you will be transferred to the ward to continue your recovery. Once on the ward, the goal is to monitor your blood pressure and heart rate and ensure adequate mobilisation. We work very closely with our nurses, physiotherapists and occupational therapists to work on breathing exercises and functional mobilisation. Every patient is different and the assistance is tailored to your needs. Patients who have undergone robotic surgery may leave the hospital after 3-4 days, however the patient should dictate when they feel ready to leave hospital.
Patients who have undergone robotic lung surgery can often be discharged within 2 or 3 days following surgery with far reduced pain compared to traditional lung surgery.
What Does Robotic Heart Surgery Involve
During robotic-assisted heart surgery, your surgeon:
- Makes a few small incisions in the chest.
- Inserts a small high-definition camera into the chest to visualize the heart.
- Inserts the robotic arms into two of the chest incisions.
- Views 3D images of the heart on a computer monitor.
- Repairs damage to heart valves or other structures using the robotic arms and monitor.
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Minimally Invasive Approaches To Cabg Surgery
Depending on the condition of the patient and consultation between the surgeon and cardiologist, beating heart bypass may be performed with traditional “open-heart” surgery or minimally invasive, robotic-assisted keyhole .
Another minimally invasive approach is endoscopic harvesting of veins from the legs and/or radial artery from the arm. With this approach an endoscope is connected to a video camera and inserted through a one-inch opening to view and remove veins and arteries to be used as bypass grafts, to channel the blood.
Lankenau Medical Center is one of the highest volume robotic coronary artery bypass heart surgery centers in the country, performing over 1,400 procedures since 2005.
Is The Risk Of Robotic Heart Surgery Different From Traditional Heart Surgery
Clifton Lewis MD: The complications that you can run in to can differ a little. There is no real evidence to suggest that a robotic mitral valve operation, the most common type of robotic heart surgery, is either safer or more dangerous than a traditional operation. The advantage of a robotic heart surgery is quicker recovery and a nicer cosmetic result. There is some evidence suggesting a lower risk of transfusion with a robotic approach as well as a lower risk of infection. I personally feel that it is technically easier to repair a mitral valve through the right chest with a robot than with a traditional approach through the breastbone.
Traditional vs Robotic heart surgery instrumentation.
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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:
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.
How Is Tecab Performed
The da Vinci robot is a highly sophisticated tool that enables the surgeon to perform the procedure with greater precision and control than is possible in traditional hands-on surgery. The surgeon sits in a console equipped with controls that direct robotic arms to perform the surgery. The robotic arms are very agile and work as an extension of the surgeon’s hands. A tiny camera attached to the robotic arms gives the surgeon a very detailed, 3-D view of the operating space inside the chest.
The entire operation is performed as a closed-chest procedure. The heart continues to beat during the surgery and no heart-lung bypass machine is required. Internal mammary artery grafts are most frequently used, so grafts are rarely harvested from other parts of the body, such as the arm or leg.
Surgeons here use two internal mammary arteries for bypass grafts because these are among the “cleanest” and most durable vessels in the body. The mammary arteries of the average 80-year-old are usually plaque-free. The da Vinci robot makes it easier and safer for the surgeon to harvest these grafts. And because the breastbone is not split during a TECAB procedure, our surgeons are not concerned that the mammary arteries are put to a new use circulation is maintained in the thoracic cavity.
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Data Analysis And Synthesis
We tabulated data extracted from included studies to facilitate quantitative and qualitative analysis. Data were assessed for potential meta-analysis.
Characteristics of included studies and findings were synthesized narratively.
We conducted meta-analyses using a random-effects model6 to calculate the summary statistics. A p value of < 0.05 was considered statistically significant. We pooled studies reporting continuous data using the mean difference between surgical groups, and those reporting categoric data using odds ratio. We assessed heterogeneity using the I2 statistic. When heterogeneity was 50% or more,3 it was considered substantial, and the studies were not pooled. In cases of multiple studies published from an institution with overlap of patients and the same outcome measures, we included only the most recent publication and largest sample in the synthesis. We used RevMan software version 5.3 to conduct the meta-analyses.
Greater Success And Faster Recovery Through Robotic Heart Surgery
Robotic heart surgery allows surgeons to operate on your heart through tiny openings in the chest, eliminating the need to cut the breastbone and spread the ribs. All four chambers of the heart can be accessed from the right side of the chest using the da Vinci® Robotic System. Only small holes are necessary, with no disturbance of the chest skeleton, making this surgery minimally invasive.
Since the chest is entered through five tiny holes, you can resume normal activities more quickly than if the operation is done by opening the chest. Robotic heart surgery can also provide you with the following benefits:
- Quicker return to a normal lifestyle
- Shorter recovery time in the hospital
- Fewer blood transfusions
- Potentially lower rates of stroke other complications
- Less pain after surgery and reduced need for narcotics
- Fewer restrictions after surgery
- Lower risk of infection
Additionally, robotic heart surgery has increased valve repair success rates to over 90%, due to surgeons’ improved visualization of the valves through the robot and the ability to perform complex repair techniques. This increased repair rate reduces the need for valve replacement, providing a better outcome for our patients.
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Explore The Da Vinci Surgical System
The high-resolution 3-D stereo viewer is designed to provide surgeons with an immersive experience. Unlike conventional approaches, surgical field appears at high-magnification, brilliant color and natural depth of field. This allows the surgeon to dissect nerves accurately with minimal trauma and allows for greater nerve preservation during the operation. To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s four robotic arms, which securely hold the patented EndoWrist instruments and high-magnification endoscopic camera.
EndoWrist instrumentsThe EndoWrist instruments’ jointed-wrist design exceeds the natural range of motion of the human hand motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements.
These advantages enable better outcomes when operating in confined environments experienced during minimally invasive surgery.
The da Vinci Surgical System
Surgeons at the Heart and Vascular Center understand that not everyone who might benefit from robotic heart surgery will feel comfortable with new advances. If patients remain wary about robotic heart surgery after face-to-face discussions with our surgeons, their Montefiore team will discuss traditional heart surgery.
Diagnosis Before Robotic Heart Surgery
Preparing for surgery
In order to check if you are eligible for the surgery, your medical history along with your lifestyle is reviewed to understand the severity of the disease.
- You are given a consent form for permission and asks you to read instructions in case something is unclear.
- This is followed by a physical exam to check your health and understand the impact of the procedure on your body.
- You need to take special precautions if you are pregnant.
- You need to tell your healthcare provider in case you are allergic or sensitive to something like medicines, tape, contrast dyes, latex, iodine, anaesthetic agents etc.
- In case you are taking any other medicines or herbal supplements, you need to inform your healthcare provider.
- You need to inform your doctor if you have had a history of bleeding disorder or if you are taking blood thinners, or any other medicines that affect blood clotting. In most cases you are asked to stop taking these medicines before the procedure.
- You need to inform your doctor in case you already have a pacemaker or any such device implanted.
- In case of smokers, they are suggested to take a break from smoking as it helps in faster recovery.
- You are expected to stop drinking and eating at least 8 hours before the surgery.
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What Conditions Might Benefit From Robotic Heart Surgery
At Yale Medicine, robotic surgery is primarily used for patients who need mitral valve repair and coronary artery bypass surgery. However, the da Vinci Xi Surgical System can be used for other heart-related surgery. Your surgeon may use it for one of the following procedures:
- Tricuspid valve repair and replacement surgery
- Combined mitral and tricuspid valve surgery
- Removal of cardiac tumors
What Can I Expect When I Come Home From The Hospital
Youll receive at-home care instructions that are specific to the procedure you had. They typically include:
- Taking it easy for a few days or however long your surgeon recommends.
- Resuming everyday activities gradually. If youre not on prescription pain medications, you can start driving when youre ready.
- Not lifting anything heavy until you follow up with your doctor.
- Watching for signs of infection near your incision site.
- Taking medications for pain or constipation.
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What Are The Risks Of Surgery
As with any surgery, there are risks involved. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation. Your doctor will discuss your personal risks before surgery please ask questions to make sure you understand all of the potential risks.