What is Robotic Heart Surgery and Robotic Mitral Valve Surgery All About?

Robotic heart surgeons operate from a console next to the patient and control the tiny robotic instruments.

What is robotic heart surgery?  Traditional heart surgery is performed by dividing the breastplate with a saw (sternotomy).  Robotic heart surgery is a form of minimally invasive heart surgery that allows a surgeon and their team to use dexterous robotic instruments and a robotic high-definition 3D camera to perform precision surgery through tiny incisions.  Avoiding open surgery may lead to faster recovery. The surgeon sits next to the patient and controls the robot.

Although results vary for individuals, the endoscopic robotic approach may allow patients to return to normal activity faster than with sternotomy!  An example of a commonly performed robotic operation that we perform is totally endoscopic robotic mitral valve repair.  The robotic system is particularly useful for this problem as it allows for excellent visualization for mitral valve repair.

Recent robotic mitral valve repair patient playing golf 2 weeks after surgery! Recovery time varies but this shows what is possible. Posted with permission of the patient.

Robotic instruments have the same dexterity and range of motion of a surgeon’s hands but are much smaller (maximum of 8 mm in diameter). Also, the robotic system helps to smooth out the surgeon’s hand and finger motion by using a “fly by wire” type of approach similar to that used in modern jet aircraft. In other words, things like a tremor can affect the movements of a surgeon’s hand, however, these types of unwanted movements are eliminated by the use of the robotic system. Additionally, the ability to precisely control the high definition 3D camera of the robotic system and steer it easily into position along with a small robot-controlled surgical retractor allows for excellent visualization.

Precision Robotic Surgical Procedures Require a Team Approach and Experience

To perform robotic heart surgery, a highly trained and experienced surgeon and an equally experienced team are required. Just like a pit crew in racing, this team must function together flawlessly to achieve a high level of performance. 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).

Learn from this website what robotic mitral valve surgery and other types of robotic heart surgery procedures are all about! Procedures that can be performed robotically include mitral valve repair, maze procedures to treat atrial fibrillation, atrial septal defect closure, atrial myxoma removal, tricuspid valve repair, septal myectomy for hypertrophic cardiomyopathy, coronary artery bypass, pacemaker lead insertion, and others.

Endoscopic Robotic Mitral Valve Repair

Example of a Mitral Valve Repair

Mitral valve repair is particularly amenable to the robotic approach because the mitral valve is inside a small chamber in the heart (the left atrium) and is most easily seen from the right side of the chest.  The robotic system allows the surgery to navigate into this small space and see clearly because of the high definition robotic camera.  Also, the extreme dexterity and freedom of movement of the robotic instruments allow the surgeon to perform complex mitral valve repair techniques.

The most important factors 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 focusing on mastering robotic surgery gaining enormous) experience at every level including extensive formal and informal robotic cardiac surgery.

A catheter-based system is used to connect the patient to the heart-lung machine

An important part of robotic mitral valve repair surgery is the use of catheters to put the patient on the heart-lung machine, which takes over the function of the patient's heart and lungs.  This allows the surgeon to repair the mitral valve.  Traditional mitral valve surgery does the same thing but instead uses larger pipe-like tubes called "cannulas" to accomplish the same task through a large chest incision.

Another issue to be aware of is that many hospitals and surgeons claim to do robotic heart surgery, but very few are doing it routinely and exclusively through tiny incisions. I mostly do what I consider to be totally endoscopic procedures, which I define as: the incisions being so small (usually 8-15 mm) that you cannot see into the chest directly to do any portion of the procedure.  For totally endoscopic robotic mitral valve repair, the large largest incision that I make in the chest is only 15mm, about the diameter of a finger!

Keep in mind, that depending on what their problem is, most patients undergoing heart surgery will still need a standard incision.  However, many heart surgery procedures are easily performed with the robot. Also, understand that there are many different techniques and methods to repair your mitral valve.  There are many excellent surgeons who use alternative techniques with great results (such as a sternotomy, mini-sternotomy, "port access" mini-thoracotomy, and others).

Dr. Guy performing a mitral valve repair with the Da Vinci® Robot

That being said, I sincerely believe in robotic cardiac surgery for an appropriate patient because it allows me to make truly tiny incisions to do the operation, avoid a sternotomy (sawing open the breastplate), and see and repair the mitral valve with great clarity and precision.

The purpose of this website is to provide you with detailed information about robotic cardiac surgery from a surgeon who does it and empower you so that you can make informed choices about your medical care.  Ultimately the decisions are yours.  I want to make sure you are able to make informed decisions and truly understand your options.