What is robot-assisted cardiothoracic surgery or Robotic cardiothoracic surgery? When is it recommended?

Conventionally, open cardiac surgery involves a sternotomy i.e. cutting through the breastbone and opening the ribs. This invasive technique results in significant trauma, prolonged healing time and increased risk for serious complications.

Robotic assistance offers minimally invasive surgery so the chest is not opened. Instead, the robotic arms of the surgical system operate through several small incisions called ports, which are made along the side of the chest. The surgeon is in full control of his actions throughout the procedure and is able to perform the procedure with greater precision.

Robot-assisted cardiothoracic surgery can be offered for various conditions which include:

Cardiac surgeries:

• Mitral and tricuspid valve repair
• Coronary Artery Bypass Grafting (CABG)
• Atrial fibrillation ablation
• Removal of a cardiac tumor
• Congenital heart surgery, such as Atrial Septal Defect (ASD) repair and Patent Foramen Ovale (PFO) repair
• Heart transplants

Thoracic & lung surgeries:

• Lobectomy & Pneumonectomy
• Decortication
• Lung volume reduction surgery
• Thoracoabdominal Aneurysm Repairs
• Lung transplants

A robotic surgical system has several key features that make it ideal for minimally invasive surgery. It comprises of a surgeon console, an instrument cart, and a visioning platform.

The surgeon controls these instruments and the camera from the console. By placing his fingers into the master controls, the surgeon is able to operate all arms of the surgical system simultaneously. The high definition 3D camera provides a better, more detailed, magnified (12 times), 3-D view of the surgical site. Finger and wrist movements of the surgeon are registered through sensors and translated into motion in the robotic arms with great precision.

 

What is robot-assisted surgery?

Robotic surgery, or robot-assisted surgery, is an advancement in surgical technology where surgeons perform complex surgeries using a computerized robotic arm with small tools attached to it. The minimally invasive technique results in smaller incisions and precise motion control, offering improved patients outcomes.

What are the technical advantages of robotic cardiothoracic surgery or robot assisted cardiothoracic surgery?

Robotic surgery can be considered superior to both conventional open surgery and endoscopic surgery in many ways. Some of the technical advantages of the procedure are:

• The technique provides a three-dimensional and magnified vision of the surgical site for better perception of depth of the operative field.
• The movements of the robotic arms are more precised and fine.Robotic surgery allows tremor-free movements, provides ambidexterity and is free from the fulcrum effect associated with the use of long-shafted endoscopic instruments.
• The multi-jointed endo-wrist, which are wrist-like articulating instruments of the robotic system allows the surgeon to operate within a small area such as the left atrium of the heart.
• The most recentrobotic systems are equipped with an added arm which can be utilized for left atrial retraction or as an assisting arm in coronary anastomosis.

What are the advantages of robotic cardiothoracic surgery over open cardiothoracic surgery, especially in terms of patient outcomes?

The robot-assisted cardiac surgery is performed using keyhole incisions, hence it offers the advantages of:

• Lesser trauma due to minimal invasion surgery
• Faster healing and less scarring due to smaller incisions
• Reduced blood loss
• Lesser postoperative pain
• Shorter recovery time
• Lesser risk of infection
• Shortened hospital stays
• Quicker return to normal activity and work

What are the risks and benefits involved in robot-assisted cardiothoracic surgery?

As with any surgery, there is some degree of risks involved with robot-assisted surgery. However, the risk involved is minuscule.

The benefits of robot-assisted surgery outweigh the risks involved, thus robotic assisted surgery is preferred over open surgery nowadays. The benefits associated with robotic cardiothoracic surgeries are:

• Reduced risk of post-surgical infection
• Rare life-threatening risks such as stroke, bleeding and infections
• Lesser chances of damage to nearby organs in cardiothoracic space
• Lower in-hospital mortality rates
• Faster recovery time and return to normal activities
• Smaller incisions, resulting in reduced risk of infection
• Reduced complications related to anesthesia

What are the success rates of robot-assisted cardiothoracic surgery or robotic cardiothoracic surgery?

The outcome of a surgery is largely dependent on the patient’s characteristics like presence of co-morbidities, age, and overall systemic condition. A major benefit of robotic cardiac surgery is that it has fewer risks than open-heart surgery, thus offering improved outcomes and success.

What factors should be considered while choosing a hospital for robot-assisted cardiothoracic surgery?

Cardiothoracic surgery is considered to be a major surgery. For successful and safe cardiothoracic surgery experience, consider the following factors:

• State-of-the-art robotic surgery technology and robotic systems.
• A healthcare center with advanced surgical facilities and healthcare team led by qualified and experienced cardiothoracic surgeon.
• Expertise of the team in robotic surgery. Specialized training in robotics, number of surgeries performed and success rate indicate the expertise of surgeon.
• Availability of the necessary infrastructure like diagnostics, pharmacy, OT and ICUs to support the pre-operative and post-operative needs is as important as a well-trained team.

What factors govern the cost of robot-assisted cardiac surgery?

The cost of surgery is usually affected by factors like:

• Experience and expertise of the cardiothoracic surgeon and his team
• Surgery facilities and equipment
• Length of surgery and post-surgical complications
• Hospital Stays
• Diagnostic tests andmedicines
• Underlying co-morbidities and age of the patient which may affect the –number of days in the hospital, requirement of additional tests, medication etc

To know more about robot-assisted cardiac surgery, you can request a call back and our cardiothoracic surgery specialist   will call you and answer all your queries

References:

• Ishikawa N. Robot-Assisted Cardiac Surgery. Ann Thorac Cardiovasc Surg. 2015; 21: 322–328.
• Kim ER, Lim C, Kim DJ, et al. Robot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience. Korean J Thorac Cardiovasc Surg. 2015; 48:99-104.
• Pettinari1 M, Navarra E, Noirhomme P, et al. The state of robotic cardiac surgery in Europe.Ann Cardiothorac Surg. 2017; 6(1):1-8.

Disclaimer:

“The content of this publication has been developed by a third party content providerwho are clinicians and/or medical writers and/or experts. The information contained herein is for educational purpose only and we request you to please consult a Registered Medical Practitioner or Doctor before deciding the appropriate diagnosis and treatment plan.”