What is robotic surgery?

Robotic assisted heart surgery is a new technology that allows cardiac surgeons to perform select types of heart surgery through very small incisions, and may change the way heart surgery is performed in the future. The goal is to decrease incision size and hospital stays while improving patient comfort and lessening recovery time.

 How does it work?

• Three tiny incisions (holes or "ports") are made within the spaces between the ribs.
• The robotic arms and a tiny camera are placed through these ports.
• Motion sensors are attached to the robotic "wrists" so that the surgeon can control the movement. Instruments are then attached to the robotic arms.
• The surgeon sits at a computer console and looks through two lens, one for each eye, connected to two cameras inside the patient. This allows a clear, three-dimensional image inside the patient's body. Precise camera control, via foot pedals, allows the surgeon to zoom in or out and change the surgical view instantly.
• The surgeon's hands are used to control two endoscopic instrument arms within the patient. At the end of the instrument arms are tiny instruments, designed to mimic the movements of the hands and wrists yet, possibly more precisely than the surgeon can do naturally.
• The surgeon uses small surgical instruments to perform the heart surgery. The surgeon is always in control. There is no chance that the robotic arms will move on their own.
The advantages of robot-assisted surgery include the potential for:
• Less trauma - the small incisions are made in the spaces between the ribs rather than cutting through the breastbone (sternum)
• Less trauma results in less pain and less use of pain medicine. Nonsteroidal anti-inflammatory medications are prescribed to relieve the discomfort after surgery.
• Less bleeding
• Less infection
• Shorter hospital stays than those for traditional minimally invasive surgery
• Minimal scarring
• Quicker return to normal activities - in about 2 weeks, after your cardiologist examines you and approves it. Your doctor will talk to you about lifting, driving and other recovery issues.

It is important to note that these are possible benefits. There may be no benefit for you over more traditional surgery.

Who is a candidate?

Robot assisted surgery is not for everyone. Prior to surgery, all patients have a cardiac catheterization and chest x-ray. Echocardiogram and/or computed tomography (CT) scan may also be required to provide more information about the patient's anatomy and heart disease. Based on the results of these tests and your specific medical condition, the surgeon will determine if you are a candidate.

What is Robotic surgery used for?

Robotic surgery is used to assist the surgeon during coronary artery bypass surgery.

• Traditionally, bypass surgery involves placing the patient on the heart-lung bypass machine (to circulate oxygenated blood during surgery); creating a 6 to 8 inch incision to visualize the heart; stopping the heart in order to stabilize the blood vessels; and performing the bypass procedure.
• Minimally invasive bypass surgery decreases the size of the incision to about 3-4 inches. Depending on the technique, the surgeon may choose to perform surgery on a "beating heart" or off the heart-lung bypass machine ("off-pump").
• Robot-assisted surgery is used in combination with traditional minimally invasive surgery to perform the bypass surgery through a much smaller incision. The robotic arms are used to open the pericardium (sac that surrounds the heart) and to harvest the mammary artery (in the chest wall) through a very small incision. Then, the surgeon uses the mammary artery to bypass a blocked heart artery through a minimally invasive incision. In most cases, the sternum or breastbone does not need to be opened.

Robot-assisted surgery has other uses.

• Biventricular pacing

o When a patient has heart failure, often times the right and left ventricles do not pump together (dysynchrony). When the heart's contractions become out of sync, the walls of left ventricle (LV) do not contract at the same time. The heart has less time to fill with blood and is not able to pump enough blood out to the body. This eventually leads to an increase in heart failure symptoms.

Robotic surgery can be used to place left ventricular leads on the surface of the left ventricle. These leads are then attached to a biventricular pacemaker to "resynchronize" the heart beat and improve heart failure symptoms. Click here to learn more about biventricular pacingT

• Treatment of paroxysmal atrial fibrillation (an intermittent irregular heart rhythm that occurs in the upper chambers of the heart.

o Robot assisted surgery can be used to open the pericardium and place the catheter for ablation (application of energy to correct the abnormal rhythm).