Risks of Robotic Heart Surgery

If you want robotic heart surgery, we will have a serious discussion about the risks and the alternative medical and surgical treatments.  There is no way to undergo heart surgery of any method with zero risks no matter how hard we work to do so.  All I can say is that I will treat you or your family member as if you were my family and there is nothing within my power as a physician I will not do to keep you as safe as possible.  I believe most cardiac surgeons feel the same way about their patients which is one of the reasons I chose this specialty in the first place!  However, there are very real risks when undergoing heart surgery.  All the same complications of traditional open surgery can occur with robotic heart surgery.  Additionally, there are some complications that are unique to robotic and minimally invasive approaches.  Overall, most studies have shown mortality (risk of death) to be statistically the same as open surgery.  Complications that have been uniquely associated with robotic heart surgery include (but are not limited to):  need to convert to open techniques, aortic dissection (tearing of the layers of the aorta which can even be fatal), stroke (may be higher although debated and not well proven), injury to the major blood vessels or the heart due to catheter placement, injury to the liver (the liver actually sits partially in the right chest where we work-although we do maneuvers to prevent it), chronic chest wall pain, re-operation, injury to the leg artery or vein, deep venous thrombosis, lymphocele (collection of fluid in the groin area), unilateral pulmonary edema on the side of the operation (fluid in the lung, can be serious, is not common but can happen), nerve injury from positioning, and others.

Complications of both open and robotic surgery include but are not limited to: death (probably the same with robotic and non-robotic approaches), stroke (may be elevated with minimally invasive techniques although not well proven), bleeding (less with robotic approaches), infection (less with robotic approaches), myocardial infarction (heart attack), re-operation, injury to skin, nerves, or other adjacent organs, atrioventricular disruption (rare but can occur in mitral valve surgery: separation of atria and ventricle with 80% mortality in the OR), need to replace valves if repair fails either short or long-term, SAM (systolic anterior motion of the mitral valve-where one of the leaflets obstructs blood flow from the heart), prolonged ICU or hospital or rehabilitation facility stay, irregular heartbeat, heart attack, heart failure, heart block requiring temporary or permanent pacemaker, kidney or multi-system organ failure, prolonged use of the ventilator (breathing machine), and many others.  Only after a thorough evaluation by your physician and a surgeon can your unique risks be reasonably predicted.

The Intuitive Surgical Inc. (manufacturer of the robotic system) references potential complications on their website in a fairly comprehensive way: “All surgery presents risk, including da Vinci® Surgery and other minimally invasive procedures. Serious complications may occur in any surgery, up to and including death. Examples of serious or life-threatening complications which may require hospitalization include injury to tissues or organs, bleeding, infection or internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Risks of surgery also include potential for equipment failure and human error. Risks specific to minimally invasive surgery may include: A long operation and time under anesthesia, conversion to another technique or the need for additional or larger incisions. If your surgeon needs to convert the procedure, it could mean a long operative time with additional time under anesthesia and increased complications.  Patients should talk to their doctors about their surgical experience and to decide if da Vinci Surgery is right for them. Other options may be available. Intuitive Surgical reviews clinical literature from the highest level of evidence available to provide benefit and risk information about use of the da Vinci Surgical System in specific representative procedures. We encourage patients and physicians to review all available information on surgical options and treatment in order to make an informed decision. Clinical studies are available through the National Library of Medicine at www.ncbi.nlm.nih.gov/pubmed.”