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Robotic Procedures: Beginning of the End for Open Heart Surgery?

Robotic Procedures: Beginning of the End for Open Heart Surgery?
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By    |   Thursday, 28 September 2017 12:43 PM

Robotic surgery is revolutionizing the way coronary artery bypass graft surgery (CABG) is being performed – and it may render open heart surgery obsolete.

“Robotic surgery has been around for a while, but it wasn’t the best thing for heart surgeons,” notes Dr. Kourosh Asgarian, a cardiothoracic surgeon with Mid-Atlantic Surgical Associates. “But then the technology got better, and we said, ‘Okay, we can now do the operation without cutting the patient in half.’ There’s a lot of benefit to that.”

CABGs are done to bypass arteries that supply blood to the heart muscle but are obstructed, often by the buildup of plaque.

In the standard open heart procedure – called a sternotomy – a large incision is made down the center of the chest, and a saw is used to cut through the sternum, which is pulled apart to expose the heart. Then, veins harvested from the legs are used as grafts to detour blood flow around the obstruction.

But with the help of the da Vinci Xi surgical robot, just three small incisions are needed. Surgical instruments and a camera are threaded through them, and the internal mammary artery is used to redirect the blow flow.

“That mammary artery is the best graft for heart surgery,” says Asgarian, who’s based at the Jersey Shore University Medical Center in New Jersey. “It’s better than the leg veins, so the patients get the best benefits.”

The robotic surgery is less traumatic than open heart, which Asgarian says translates into better outcomes, shorter hospital stays and less chance of complications. Recovery is also much faster.

“You get back to being functional in two weeks or less, compared to about six weeks for an open-chest operation,” he adds. “That means a lot for people who can’t afford to take that much time off work or people who own a small business.”

While robotic surgery may be easier on patients, it’s tougher on the doctors in some ways.

“It’s a longer procedure and more tedious,” says Asgarian. “You have to take your time. But the robot provides me with a superior ability to do the operation.”

In a sternotomy, the surgeon stands by the operating table and works on the exposed heart to perform the bypass. When using the robot, the surgeon does it remotely.

“I’m about 10 feet away, and when I move, the robot moves,” says Asgarian. “The robot is programmed so that my gross movements are translated to microscopic movements. And I don’t see the whole heart, just the part I’m working on. The camera we use has ridiculously good optics, 10 to 20 times better than regular vision.”

Only about 10 percent of the CABGs performed in the U.S. are done robotically, but Asgarian expects that number to climb dramatically.

“It’s a technically-challenging operation, and a lot of the older surgeons don’t learn that technology,” he explains. “Younger surgeons are more open to doing operations that way, so we’re sure to see more and more of it being done in the future.”

One disadvantage to robotic CABGs is that they can’t be used for emergency surgery, like in a case where a patient goes into cardiac arrest.

“With an open-chest procedure, you can get inside the patient in a few minutes,” explains Asgarian. “With the robot, it takes a lot of time to prepare the equipment, so it’s not something you want to do in an emergency.”

Asgarian says it’s relatively easy to learn how to use the robot. Training is done on simulators, then practiced on cadavers. Surgeons are closely monitored when first using it on live patients before they are certified.

“It’s like the best video game you’ll ever play,” says Asgarian, one of the few surgeons using the groundbreaking technology in the Mid-Atlantic region. “The robot is an important tool for the future. If we can eliminate open heart surgery someday, that would be great. It would really benefit the patients.”

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A small but growing number of heart surgeries are being performed with robotic devices. Could it mean the end of open heart surgery? Here's an important medical update.
heart, surgery, robotic, cardio
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2017-43-28
Thursday, 28 September 2017 12:43 PM
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