Dr Arvind Kohli
We hope you never need heart surgery, but if you do it’s important to know what options are available to you. This is an introduction to some of the approaches that are used today, with an emphasis on cardiac surgery performed with the da Vinci® Surgical System, a recent innovation that uses robotic instrumentation to allow cardiothoracic surgeons to operate through a smaller opening.
Patients who undergo a minimally invasive procedure such as robotic heart surgery typically experience shorter recovery times than those who have open heart surgery. These minimally invasive alternatives use a set of small ports, instead of cutting the chest open and splitting the breast bone.
Minimally invasive techniques can be used for a variety of procedures, including coronary bypass surgery, mitral valve repair, atrial septal defect (ASD or PFO) closure, or mitral valve replacement.
The da Vinci Surgical System comprises three components:
1 a surgeon’s console,
2 a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments),
3 a high-definition 3D vision system.
Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled- down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon’s hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon’s console.
Advantages of this technique are that the incisions are small and patient recovery is quick. In traditional open-heart surgery, the surgeon makes a ten to twelve-inch incision, then gains access to the heart by splitting the sternum (breast bone) and spreading open the rib cage. The patient is then placed on a heart-lung machine and the heart is stopped for a period of time during the operation. This approach can be associated with postoperative infection and pain, and prolonged time to complete recovery.
Because patient recovery after robot-assisted heart surgery is quicker, the hospital stay is shorter. On average patients leave the hospital two to five days earlier than patients who have undergone traditional open-heart surgery and return to work and normal activity 50% more quickly,
Reduced recovery times are not only better for the patient, they also reduce the number of staff needed during surgery, nursing care required after surgery, and, therefore, the overall cost of hospital stays.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly.
Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.
Disadvantages to Robotic surgery
Robotic surgery is “a new technology, so its uses and efficacy have not been fully determined. Consequently, there are not many extensive long-term studies on the procedure to confirm or deny its effectiveness. There are, however, prominent disadvantages to robotics, including time, cost, efficiency, and compatibility with current systems.
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.
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.
Future
The da Vinci robotic surgery is being preferred for the advantages associated with it. While the drawbacks may limit its widespread use, further innovations in the technology can help overcome these drawbacks. Better care, minimal pain and faster recovery are some of the positive features of the da Vinci robotic surgery which is increasing its popularity both among surgeons and patients.
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