What is Robotic Heart Surgery All About?
Traditionally, heart surgery is performed by dividing the breastplate with a saw (sternotomy). Robotic heart surgery allows surgeons to perform some of 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 high-definition 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 (just as a pilot controls an airplane). Many types of cardiac surgical 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 hospitals 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. 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.
It would be incredibly hard if not impossible to do these procedures through incisions of 8-15 mm without the robot. One way to understand the value of robotics compared to non-robotic minimally invasive techniques would be to compare use of chopsticks versus fork and hand to eat a meal. You certainly can eat with chopsticks but you lose the ability to easily move in more than 2 dimensions. In the simplest terms the robotic system allows the surgeon to have the same dexterity (or range of motion) of a human hand but with tiny incisions. Also the robotically-controlled high-definition 3-D camera and retractor allow the surgeon to constantly adjust the exposure and view of the surgical area. In the case of mitral valve surgery, the ability to see and work on the valve up close and in its natural position definitely makes valve repair much easier.
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. Request an appointment with Dr. T. Sloane Guy to discuss robotic heart surgery.