Robotic Heart Surgery - what's it all about?

by Dr. S. Russell Vester, MD 29. June 2013 12:04

Robotic heart surgery. What is it and on whom should it be applied? It’s amazing how many people know about it. For all that’s on the internet about it, it’s equally amazing how little folks actually understand about where it fits in the scheme of things.

 

I think the most important thing to know about the use of the surgical robot-called the daVinci robotic system made by the Intuitive Surgical corporation-is that the robot is, most simply, an additional tool for a surgeon to use. A complicated and really expensive tool, but still a tool. Like any tool, it is good for some things and not good for others. That said, patients are as transfixed by the mention of it as much as they were ten or fifteen years ago by anything medical with the word “laser” in it. Having a surgical robot is a great public relations opportunity for a hospital and the physicians that use it.

This latter issue is a pet peeve of mine. I personally think that marketing has no place in medicine. I grew up in an era when this was thought to be unethical. Putting this genie back in that bottle isn’t going to happen. I’ve gotten over this. Just remember that no medical advertising has ever been done just so the general public can consider themselves better informed.

In the heart surgery world the daVinci robot is a good tool for use in anything found in the upper chambers, the atria, of the heart. It is most frequently used for mitral valve surgery, either repair of replacement. The biggest benefit is settling out to be the more rapid recovery from the surgery since the approach is from the right side between the ribs rather than having to divide the breast bone, the sternum, as is done conventionally. Most people don’t realize that the patient is still placed on the heart-lung machine while the robot is in use. It’s impressive to me that, in the current era, the heart-lung machine is not the source of problems it used to be or that most other doctors were taught way back when they were in medical school.

This tool does have a fairly sturdy learning curve. It is complex and technically involved to use. It is much more helpful for the surgeon to already know how to do the standard operations well. Understanding and applying the intricacies of repairing a mitral valve takes years. Learning this and learning how to use the robot at the same time is a lot to ask, particularly when you consider that it’s a living patient at the business end of the robotic arms. Hopefully simulator technology will help us out here, but it’s not ready yet.

Next week I’ll tell you how our group has managed this problem. We have one of the busiest and successful robotic heart surgery programs in the country. It took years to develop, but we did it with patient safety, as always, being the highest priority. Many hospitals and/or surgeons have tried to create similar programs for what appears to be bragging rights. These hospitals and surgeons have lost their way.

 

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