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Robot-Assisted Cardiac Procedures
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Robot-Assisted Cardiac Procedures

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Overview ; Urologic Procedures ; Laparoscopic Procedures ; Cardiac Procedures; Thoracic Procedures

Definition

A surgeon guides robotic arms to perform a cardiac surgery through several tiny “keyhole” incisions. Cardiac surgeries that have been successfully performed using robotic techniques include:

  • Mitral valve repair—surgery to repair problems with the valve between the upper and lower chambers on the left side of the heart.
  • Coronary artery bypass grafting (CABG)—surgery that creates a path around blocked heart vessels so that blood can reach the heart muscle. The bypass is done using blood vessels from other parts of the body to
  • Atrial septal defect repair—surgery to close a hole in the wall between the upper two chambers of the heart
  • Biventricular pacemaker lead placement for heart failure—surgery to place leads (wires) on the inner surface of the heart’s ventricles. The leads are attached to a biventricular pacemaker to help the heart beat in a regular rhythm.
  • New robot-assisted cardiac procedures are being added to this list all the time.

Pacemaker Placement

Pacemaker

Pacemaker leads implanted in heart to maintain normal rhythm.

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Heart
  • Chest cavity
  • Legs (in CABG)

Reasons for Procedure

Robot-assisted cardiac procedures are performed to treat a variety of conditions.

Robot-assisted mitral valve repair may be used to treat:

  • Stenosis (narrowing) of the mitral valve
  • Regurgitation (leakage) of the mitral valve

Robot-assisted CABG may be used to treat:

  • Blockages in the heart’s arteries
  • Severe chest pain ( angina ) that has not improved with medications

Robot-assisted atrial septal defect repair may be used to treat:

  • A hole between the upper chambers of the heart that does not close properly during fetal development

Robot-assisted biventricular pacemaker lead placement may be used to treat:

  • Heart failure due to atrial fibrillation (irregular heart rhythm in the upper chambers of the heart)

Risk Factors for Complications During the Procedure

A risk factor is something that increases your chances of having complications during your procedure. Risk factors for complications during robot-assisted cardiac procedures include:

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

  • Physical exam
  • Blood tests
  • Urine tests
  • Electrocardiogram (ECG, EKG)—a test that records the electrical currents passing through the heart muscle
  • Coronary angiogram—a test to determine the extent and location of blockages of blood vessels supplying the heart muscle
  • Chest x-ray
  • Ultrasound—a test that uses sound waves to visualize structures inside of the chest
  • CT scan—a type of x-ray that uses a computer to create images of structures inside the chest
  • MRI scan—a test that uses powerful magnets and radiowaves to create images of structures inside of the chest
  • Review your medications with the surgeon; you may need to stop taking some drugs
  • Follow a special diet, if recommended by your surgeon
  • Take antibiotics, if prescribed by your doctor
  • Shower the night before using antibacterial soap, if your doctor asks you to
  • Arrange to have someone drive you to and from the procedure, and for help at home after your procedure
  • Eat a light meal the night before, and do not eat or drink anything after midnight unless told otherwise by your doctor
  • Plan to wear comfortable clothing on the day of your procedure

Anesthesia

General or local with sedation will be administered depending on the procedure.

Description of the Procedure

To begin a robot-assisted cardiac procedure, the surgeon cuts several small (approximately one-centimeter) “keyhole” openings in the spaces between the ribs.

The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of the heart and other internal organs on to a video screen for the surgeon to see. The endoscope is attached to one of three or four of the surgical system’s robotic arms. The other two or three arms hold other instruments such as dissectors, scissors, scalpels, or forceps. These instruments are able to grasp, cut, dissect, and suture structures during the operation.

While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified three-dimensional image of the inside of the chest. Another surgeon stays by the patient during the procedure, where he or she can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeon’s larger hand movements into smaller ones.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After Procedure

You will be moved to the intensive care unit, where your heart activity and breathing will be closely monitored.

How Long Will It Take?

Usually 1-4 hours, but this depends on the type of procedure being done.

Will It Hurt?

Anesthesia prevents pain during surgery. Patients typically experience some pain and soreness during recovery, but receive pain medication to relieve the discomfort.

Possible Complications

  • Damage to neighboring organs or structures in the chest
  • Infection
  • Pneumonia
  • Blood clots
  • Bleeding
  • High or low blood pressure
  • Stroke
  • Anesthesia-related problems
  • Death

Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (e.g., traditional endoscopic or open-heart surgery)

Average Hospital Stay

Usually 2-3 days, but may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity.

Depending on your procedure, your doctor will likely advise you to:

  • Take certain medications, including antibiotics
  • Avoid certain medications
  • Perform deep breathing and coughing exercises soon after the surgery to expand your lungs, and prevent infection and collapse
  • Sit up and move around as soon as possible after surgery
  • Wash the incisions with mild soap and water
  • Limit certain activities, such as showering, bathing, driving, walking up stairs, lifting, and working, for a period of time
  • Enroll in a cardiac rehabilitation program

Outcome

Depending on your procedure, you should be able to resume regular activities within a few weeks after your surgery. Based on evidence available to date, the risks of robotic surgery appear to be less than for more traditional forms of surgery.

Benefits of robot-assisted cardiac procedures over traditional cardiac procedures may include:

  • Reduced trauma to the body
  • Reduced risk of blood transfusion
  • Shorter hospital stay
  • Faster recovery

Call Your Doctor If Any of the Following Occurs

It is essential for you to carefully monitor your own recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. Promptly notify your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
  • Cough, shortness of breath, or chest pain
  • Difficulty urinating, such as pain, burning, urgency, frequency or bleeding
  • Severe nausea or vomiting
  • Rapid weight gain
  • Pain and/or swelling in your feet, calves, or legs
  • Headache, muscle aches, feeling faint or dizzy
  • Other worrisome symptoms

RESOURCES:

American Heart Association
http://www.americanheart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

University of Ottawa Heart Institute
http://www.ottawaheart.ca/UOHI/Welcome.do

References:

About minimally invasive and robotic cardiac surgery. Columbia University Medical Center, Department of Surgery website. Available at: http://www.columbiasurgery.org/pat/mirobotic/procedures.html . Accessed July 27, 2006.

Atrial septic defect repair. Inova Health System website. Available at: http://inova.org/inovapublic.srt/heart/pediatric_services/cardiac_surgery/atrial_septal_defect.html . Accessed July 27, 2006.

Cardiac applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/patientresources/conditions/cardiac/index.aspx . Accessed July 27, 2006.

Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405_computer.html . Accessed June 20, 2006.

Mitral valve repair. Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/patientinformation/valvesurgery/mitralvalverepair/ . Accessed July 27, 2006.

Robot-assisted heart surgery: what you need to know. Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3000/3044.asp?index=10728 . Accessed July 27, 2006.

Robots lend a helping hand to surgeons. Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2002/302_bots.html . Accessed June 20, 2006.



Last reviewed February 2008 by J. Peter Oettgen, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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