This is for you and your doctors to decide. However, I believe for that properly selected patients, it does have very real potential advantages, especially regarding faster recovery from surgery. This is my personal opinion. Although length of stay has been shown to be slightly less than standard procedures, the real benefit to the patient may be in the reduced recovery period after leaving the hospital. After endoscopic robotic surgery, you will not have “sternal precautions” which are designed to prevent disruption of your breastplate after standard surgery (no heavy lifting, no driving, no laying on your side, etc. for 6 weeks). You can usually drive and return to work once off pain medications which can be as early as 2 weeks (although every patient responds differently to surgery). After traditional sternotomy surgery, a 6 week period of recovery out of work is fairly standard. Again, let me emphasize that all patients respond differently and it is hard to predict recovery period. Also, the recovery period is often prolonged after heart surgery by any method when complications arise.

Having done mitral valve surgery in almost every conceivable way including the traditional sternotomy approach, I can tell you from personal experience that repair of mitral valve repair is easier for me because of the improved visualization afforded by the high definition 3D robotically controlled camera, the dexterity of the robotic instruments, and the fact that the heart is lays in its natural position during the repair (as opposed to standard surgery where I a surgeon has to retract the heart upward and to the left to expose the mitral valve).

The reality is that while the long-term results of robotic endoscopic surgery may be the same as standard surgery, if you are able to recover more quickly, this is very important to most patients. Many surgeons who don’t do minimally invasive or robotic techniques speak poorly of it. In my opinion, this is often an uninformed opinion by someone with little to no experience with the techniques or who “dabbled” in the technique before it became more mainstream, or who was trained in an earlier era where doing things minimally invasively was simply not valued. My own training in medicine and surgery began in 1989 when a general surgeon told me “fools” were removing gallbladders endoscopically. By 2004 when I finished all my training, it was standard of care to remove the gallbladder endoscopically in most cases. Cardiac robotics has taken a longer time to develop due to the increased complexity of the procedures but I believe it will continue to grow. I personally would not consider a sternotomy to repair my mitral valve but would go to another high-volume robotic mitral repair surgeon to perform the procedure.

It is important to understand there is great variation in the nature and quality “robotic heart surgery” procedures at different centers. To date, many clinical studies on robotic heart surgery have shown at least equivalent safety and clinical outcomes, and in some cases, superior results compared to traditional heart surgery. I think that one of the reasons it has not been proven superior yet is that so few centers do it well and those that do are very unlikely to want to switch back to large incisions to prove it. These issues are debatable and I encourage you to seek different opinions, because it is your life and your body! In the end, the most important goals of undergoing heart surgery are the same regardless of the approach: live through the experience and get the problem fixed! You and your surgeon should never compromise safety and effectiveness for small incisions.

Category: Questions about Results of Robotics
T. Sloane Guy, MD

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