Tuesday, August 18, 2009

Robotic Heart Surgery

Robotically-assisted heart surgery is a major headway in medical community’s endeavour to minimize the extent and the trauma of cardiac surgery. With this technology, the surgeon manipulates the surgical instruments with the help of a computer.

Robotically-assisted heart surgery technology involves insertion of surgical instruments through pencil sized holes, instead of the conventional way of making a 12 to 15 inch long incision required to split a patient's breast bone. An endoscope and two surgical instruments are passed through tiny incisions in the chest wall. The surgeon views the image provided by the endoscope on a computer screen. Instead of manipulating the surgical instruments directly, the surgeon manipulates them via a computer console - similar to manipulating a computer games console. The computer interprets the surgeon's hand movements and causes the surgical instruments to respond accordingly. This system addresses the major disadvantages of moving the long surgical instruments manually - computer control of the surgical instruments essentially eliminates the tremor effect, and also the non-intuitive feel of maneuvering such instruments.

The Robotic Surgical System enhances a surgeon's hands much like a microscope enhances a surgeon's eyes. This 'enhancement' gives the surgeon the extra precision and dexterity necessary to perform these very delicate procedures without having to crack the patient's chest, wide open.

While it takes special training to become adept at using robotically-assisted instruments, most surgeons who have had such training report that they feel quite comfortable maneuvering surgical instruments via a console instead of directly.

Much of the early work with robotically-assisted heart surgery has been with bypass surgery, limited to single bypass grafts. However, it is predicted that with advances in technology, multiple grafts with robotic assistance will be possible, at virtually any location on the heart.

The chief advantage of such surgery is incisions that are made are tiny, eliminating the large incision and provide the benefits of significantly reduced patient pain and trauma, shorter recovery times and convalescent periods. Rapid recovery from cardiac surgery is not only better for the patient, but it is also less expensive.

The chief disadvantage at this point is that the technology is new, and (despite early encouraging reports) is still evolving. Its efficacy and safety have not yet been proven sufficiently.
Another disadvantage is the cost of the robotic systems. The bottom line: it is likely to be several years before robotic heart surgery is widely available.

However this technology throws open new possibilities, for instance, a surgeon performing a heart operation while sitting at a console 15 feet away from the patient, can also perform with equal efficiency the same operation while sitting 1500 miles away from the patient. In other words patients could be operated upon by only the very best surgeons.
Dr. Vijay Dikshit, MS, MCh
Chief Cardiothoracic Surgeon.


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