HOW ROBOTICALLY - ASSISTED HEART SURGERY HELP SAVE LIFES

Robotically-assisted heart surgery, also called closed-chest heart surgery, is a type of minimally invasive heart surgery performed by a cardiac surgeon. The surgeon uses a specially-designed computer console to control surgical instruments on thin robotic arms.

Robotically-assisted heart surgery has changed the way certain heart operations are being performed. This technology allows surgeons to perform certain types of complex heart surgeries with smaller incisions and precise motion control, offering patients improved outcomes. 

Robotic Surgical System Component

The computer-enhanced robotic system consists of three components, including:

• A three-dimensional view of the surgical field, including depth of field, magnification and high resolution
• Instruments on thin robotic arms that are designed to mimic the movement of the human hands, wrists and fingers, allowing an extensive range of motion and more precision
• Master controls that allow the surgeon to manipulate the instruments, translating the surgeon’s natural hand and wrist movements into corresponding, precise and scaled movements

How is robotically-assisted heart surgery performed?

First, three small incisions or “ports” are made in the spaces between the ribs.

The surgical instruments (attached to the robotic arms), and one camera are placed through these ports.
Motion sensors are attached to the robotic “wrist” so the surgeon can control the movement of the surgical instruments.

The surgeon sits at a computer console and looks through two lenses (one for each eye) that display images from the specialized camera with two optical outputs.

From the two optical outputs, the computer generates a clear, three-dimensional image of the surgical site for the surgeon to view. Foot pedals provide precise camera control, so the surgeon can instantly zoom in and out to change the surgical view.

The surgeon’s hands control the movement and placement of the endoscopic instruments. The robotic “arm and wrist” movements mimic those of the surgeon, yet are possibly more precise than the surgeon’s natural hand and wrist movements.

The surgeon is always in control during the surgery; there is no chance that the robotic arms will move on their own.

The merit of robotically - assisted heart surgery 

 
Compared with traditional surgery, the benefits of robotically - assisted surgery may include:

• Smaller incisions with minimal scarring
• Less trauma to the patient, including less pain
• Shorter hospital stay (usually 3 to 4 days)
• Decreased use of pain medications
• Less bleeding
• Decreased risk of infection
• Shorter recovery and quicker return to daily and professional activities: The patient can resume normal activities and work as soon as he or she feels up to it; there are no specific activity restrictions after robotically - assisted surgery

The demerit of robotically - assisted heart surgery

Time
Robotic assisted heart surgery can take nearly twice the amount of time that a typical heart surgery takes, but this is variable depending on the surgeon's expertise and practice with the equipment.

In a longer surgery, the patient is under anesthesia for longer and it costs more to staff the procedure.

Cost

At this early stage in the technology, the robotic systems are very expensive. It is possible that with improvements in technology and more experience gained by surgeons the cost will fall. Others believe that with these improvements in technology the systems will become more complicated and the costs will rise. Another issue with costs is the problem with upgrading the systems as they improve. Only when these systems gain more widespread multidisciplinary use the costs will become more justified.

Efficiency and Compatibility

Another disadvantage is the large size of the system in an overcrowded-operating room. The robotic arms are awkward and bulky and there are many instruments needed in the small space. For robotic-assisted beating heart surgery, the space is even smaller because stabilizers are needed. For surgeons, this cramped area can interfere with their dexterity.

There are also concerns about technical glitches that might occur during the surgery.

Who is a candidate for robotically assisted heart surgery?

Diagnostic tests are performed to determine if you are an appropriate candidate for robotically-assisted surgery, including a cardiac catheterization and chest x-ray. An echocardiogram and/or a computed tomography scan also may be required to provide more information about your medical condition. 

Your surgeon will review the results of these diagnostic tests to determine if you are an appropriate candidate for robotically-assisted surgery. The type of treatment recommended for your condition will depend on several factors, including the type and severity of heart disease, your age, medical history and lifestyle. 

What are the risks of surgery?

As with any surgery, there are risks involved. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation. Your doctor will discuss your personal risks before surgery; please ask questions to make sure you understand all of the potential risks.