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Robot-Assisted Cardiac Procedures

Definition

A doctor guides robotic arms to do surgery on the heart. The surgery is done through several tiny keyhole incisions.

Reasons for Procedure

Robot-assisted cardiac procedures are done 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 coronary artery bypass grafting (CABG) may be used to treat:
    • Blockages in the heart’s arteries
    • Severe chest pain such as 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 , which is an irregular heart rhythm in the upper chambers of the heart.
Pacemaker Placement
Pacemaker
Pacemaker leads implanted in heart to maintain normal rhythm.
Copyright © Nucleus Medical Media, Inc.
Benefits of robot-assisted cardiac procedures may include:
  • Increased range of motion with the robotic arms
  • Ability to filter out human hand tremor and translate the doctor’s larger hand movements into smaller ones
  • Reduced trauma to the body
  • Shorter hospital stay
  • Faster recovery

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Damage to nearby organs or structures in the chest
  • Infection
  • Bleeding
  • Blood clots
  • Anesthesia-related problems
  • Death
Some factors that may increase the risk of complications include:
Be sure to discuss these risks with your doctor before the surgery.

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:
Leading up to the procedure:
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Take antibiotics if instructed.
  • Follow a special diet if instructed.
  • Shower the night before using antibacterial soap if instructed.
  • Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

There are two options for anesthesia:
  • General anesthesia —blocks pain and keeps you asleep through the surgery
  • Local anesthesia with sedation—just the area that is being operated on is numbed, given as an injection

Description of the Procedure

Several keyhole openings will be cut in the spaces between the ribs. Next, a small camera will be passed through one of the incisions. This small camera is called an endoscope. It will light, magnify, and project an image of the organs onto a monitor. The endoscope will be attached to one of the robotic arms. The other arms will hold instruments for grasping, cutting, dissecting, and suturing. These may include:
  • Forceps
  • Scissors
  • Dissectors
  • Scalpels
While sitting at a console near the operating table, the doctor will use lenses to look at a magnified 3D image of the inside of the chest. Another doctor will stay by the operating table and adjust the camera and instruments. The robotic arms and tools will be guided with joystick-like controls and foot pedals. After the instruments are removed, incisions will be closed with sutures or staples.

Immediately After Procedure

After the procedure, you will be:
  • Moved to the intensive care unit (ICU)
  • Closely monitored
  • Encouraged to sit up and move around soon after surgery

How Long Will It Take?

Usually 1-4 hours, depending on the procedure

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay depends on the procedure you had done. Your doctor may need to keep you longer if you have any problems.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:
  • Do deep breathing and coughing exercises.
  • Wash the incisions with mild soap and water.
  • Limit certain activities, such as driving and strenuous activity.
  • Enroll in a cardiac rehabilitation program.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • 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
  • Rapid weight gain
  • Pain and/or swelling in your feet, calves, or legs
  • Headache, feeling faint or lightheaded
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

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

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

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Health Canada http://www.hc-sc.gc.ca

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 25, 2013.

Atrial septic defect repair. Inova Health System website. Available at: http://www.inova.org/healthcare-services/pediatrics/types-of-services/pediatric-cardiovascular-program/procedures/atrial-septic-defect-repair.jsp. Accessed July 25, 2013.

Mitral valve repair. Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/patientinformation/valvesurgery/mitralvalverepair/. Accessed July 25, 2013.

Robot-assisted heart surgery: how it works. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/heart/services/surgery/robotically-assisted-heart-surgery.aspx. Accessed July 25, 2013.

Revision Information

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