Robot-Assisted Cardiac Procedures Overview

• Robot-Assisted Surgery—Overview

• Laparoscopic Procedures

• Thoracic Procedures

• Urologic Procedures

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

Prior to Procedure

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

• Physical exam
• Blood and 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 —a test that uses radiation to take a picture of structures inside the chest
• Ultrasound —a test that uses sound waves to visualize structures inside 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 magnetic waves to make pictures of structures inside the chest

Leading up to the procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, such as:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
• 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

The doctor will cut several keyhole openings in the spaces between the ribs. Next, the doctor will pass a small camera 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 look through lenses. He will see magnified 3D images of the inside of the chest. Another doctor will stay by the operating table and adjust the camera and instruments. The console will have joystick hand controls and foot pedals. Using these, the doctor will guide the robotic arms and instruments. 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?

You will have pain and soreness during recovery. Ask your doctor about pain medicine.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is dependent 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:

• Follow your doctor's guidelines on taking medicine. You may need to take antibiotics.
• Do deep breathing and coughing exercises.
• Follow a special diet.
• Wash the incisions with mild soap and water.
• Limit certain activities (eg, driving, strenuous activity).
• Enroll in a cardiac rehabilitation program.
• Be sure to follow your doctor's instructions.

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/

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

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 September 14, 2009.

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

Cardiac applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/patientresources/conditions/cardiac/index.aspx . Accessed September 14, 2009.

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.