ROBOTIC HEART SURGERY

      Dr  Arvind Kohli
We hope you never need heart surgery, but if you do it’s important to know  what options are available to you. This is an introduction to some of the  approaches that are used today, with an emphasis on cardiac surgery  performed with the da Vinci® Surgical System, a recent innovation that  uses robotic instrumentation to allow cardiothoracic surgeons to operate  through a smaller opening.
Patients who undergo a minimally invasive procedure such as robotic heart  surgery typically experience shorter recovery times than those who have  open heart surgery. These minimally invasive alternatives use a set of  small ports, instead of cutting the chest open and splitting the breast bone.
Minimally invasive techniques can be used for a variety of procedures, including coronary bypass surgery, mitral valve repair, atrial septal defect (ASD or PFO) closure, or mitral valve replacement.
The da Vinci Surgical System comprises three components:
1  a surgeon’s console,
2  a patient-side robotic cart with 4 arms manipulated by the surgeon (one  to control the camera and three to manipulate instruments),
3 a high-definition 3D vision system.
Articulating surgical instruments are mounted on the robotic arms which  are introduced into the body through cannulas. The da Vinci senses the  surgeon’s hand movements and translates them electronically into scaled-  down micro-movements to manipulate the tiny proprietary instruments. It  also detects and filters out any tremors in the surgeon’s hand movements,  so that they are not duplicated robotically. The camera used in the system  provides a true stereoscopic picture transmitted to a surgeon’s console.
Advantages of this technique are that the incisions are small and patient  recovery is quick. In traditional open-heart surgery, the surgeon makes a  ten to twelve-inch incision, then gains access to the heart by splitting  the sternum (breast bone) and spreading open the rib cage. The patient is  then placed on a heart-lung machine and the heart is stopped for a period  of time during the operation. This approach can be associated with  postoperative infection and pain, and prolonged time to complete recovery.
Because patient recovery after robot-assisted heart surgery is quicker, the  hospital stay is shorter. On average patients leave the hospital two to five  days earlier than patients who have undergone traditional open-heart  surgery and return to work and normal activity 50% more quickly,
Reduced recovery times are not only better for the patient, they also reduce  the number of staff needed during surgery, nursing care required after  surgery, and, therefore, the overall cost of hospital stays.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical  instruments and a better view of the surgical site. In addition, surgeons no  longer have to stand throughout the surgery and do not tire as quickly.
Naturally occurring hand tremors are filtered out by the robot’s computer  software. Finally, the surgical robot can continuously be used by rotating  surgery teams.
Disadvantages to Robotic  surgery
Robotic surgery is “a new technology, so its uses and efficacy have not been fully determined. Consequently, there are not many extensive long-term studies on the procedure to confirm or deny its effectiveness. There are, however, prominent disadvantages to robotics, including time, cost, efficiency, and compatibility with current systems.
TIME
Robotic assisted heart surgery can take nearly twice the amount of time  that a typical heart surgery takes, but this is variable depending on the  surgeon’s expertise and practice with the equipment.
COST
At this early stage in the technology, the robotic systems are very  expensive. It is possible that with improvements in technology and more  experience gained by surgeons the cost will fall. Others believe that with  these improvements in technology the systems will become more  complicated and the costs will rise. Another issue with costs is the problem  with upgrading the systems as they improve. Only when these systems  gain more widespread multidisciplinary use the costs will become more  justified.
efficiency and Compatibility
Another disadvantage is the large size of the system in an overcrowded-  operating room. The robotic arms are awkward and bulky and there are  many instruments needed in the small space. For robotic-assisted beating  heart surgery, the space is even smaller because stabilizers are needed.  For surgeons, this cramped area can interfere with their dexterity.
Future
The da Vinci robotic surgery is being preferred for the advantages  associated with it. While the drawbacks may limit its widespread  use, further innovations in the technology can help overcome these drawbacks. Better care, minimal pain and faster recovery are some of the positive features of the da Vinci robotic surgery which is increasing its popularity both among surgeons and patients.

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