Robotic Surgery is the least invasive way to perform heart and lung surgery. Dr Bassin is able to offer patients robotic cardiac and thoracic surgery if they are suitable candidates. Patients are able to regain their optimal health and return to their everyday life faster than ever before.
Da Vinci Robot
The Da Vinci Robot from Intuitive Surgical Inc. is the only approved tele-manipulator licenced for surgical use. The system has been in use for 15 years and is widely used for heart and lung surgery, as well prostate, bowel and gynaecological operations.
What is Robotic
Robotic assisted cardiothoracic surgery can facilitate mitral valve surgery, coronary bypass surgery and a range of other heart and lung operations. The robotic assistance aids the surgeon in visualisation, precision and control and also minimises the size of the incisions. This hastens the recovery considerably and also reduces the pain and trauma of traditional open surgery.
During robotic surgery a camera is placed inside the chest that provides the surgeon with a 3D view and 10x magnification. This is vastly superior to anything available in conventional surgery. A number of small instruments are then introduced into the chest that precisely mimic the actions of the surgeon. The surgeon controls these robotic instruments inside the patient from a console. These movements are scaled down to maximise the precision. The surgeon is in control of the Da Vinci the entire time – there is no automation of the robot.
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Robotic Mitral Valve Repair/ Replacement
Robotic surgery is available for mitral valve repair or replacement in patients with mitral valve disease. The most important aspect of mitral valve repair surgery is the quality and durability of the repair. The robot enhances visualisation and control for the surgeon to help achieve the best surgical outcome. The other main advantage of robotic surgery is that the operation is performed minimally invasively (mini mitral) without needing to split the breastbone (sternum) through 4 or 5 keyhole incisions. This enhances recovery, reduces pain and improves the cosmetic outcome.
Dr Bassin will discuss with each patient whether they are suitable candidates for safe and effective robotic mitral valve surgery. There are many factors that determine their suitability such as: cardiac function, additional heart valve conditions and previous vascular disease. Dr Bassin will take these factors into account for each individual patient, since the main priority is achieving an optimal mitral valve repair.
Robotic mitral valve repair or replacement is performed through 4 or 5 keyhole incisions for the robotic arms to access the heart. A separate incision in the leg connects the patient to the heart-lung machine during the surgery.
Robotic Coronary Bypass
Coronary bypass surgery is required for patients with complex coronary artery disease. The common indications for surgery include patients who have disease in all three coronary arteries, patients with diabetes and patients with poor heart muscle function. Bypasses are commonly fashioned from the internal mammary artery behind the chest wall or veins from the leg. The best long-term results are achieved with bypasses using the left internal mammary artery (LIMA) to the most important coronary artery – the LAD. This has been shown over the last 40 years to increase the survival of patients when compared to other treatments.
Robotic bypass surgery involves performing a LIMA to LAD bypass without having to split the breastbone (sternotomy). If there are remaining blocked coronary arteries, these can be addressed by an interventional cardiologist with coronary stents. The combination of robotic bypass and stenting is termed ‘Hybrid Cardiac Surgery.’
The advantage of robotic bypass surgery is that the recovery is far quicker, with patients able to get back to work in a few weeks with minimal limitation on their activities. This is in stark contrast to open bypass surgery that usually requires at least 6 weeks off work and 3 months of avoiding strenuous activity while the sternal bone heals. Other advantages include less pain, reduced need for blood transfusion and an improved cosmetic result.
Robotic Lung Surgery
The most common lung procedure performed by the surgical robot is the removal of lung tumours or cancers. The robotic assistance aids in visualisation and precision and also enables the surgeon to remove the lung tumour without having to open the chest. Minimally invasive lung surgery has been shown to significantly reduce post-operative pain, as well as some of the associated complications of major lung surgery such as: difficulty breathing, inflammation, air leak, long-term pain, blood transfusion and infection.
The thymus is a gland that lies behind the breastbone (sternum) and is part of the immune system. Tumours may develop in the thymus or the thymus may participate in generating antibodies that attack the muscle receptors, resulting in severe muscle weakness – a condition called myasthenia gravis. Removal of the thymus (thymectomy) can be indicated for tumours or for myasthenia gravis. Traditionally this surgery has been performed as an open procedure with a sternotomy, completely splitting the breastbone. Robotic technology has enabled a thymectomy to be performed minimally invasively with just a few keyhole incisions in the chest wall.
The Robotic Surgery Team
Robotic surgery requires that the surgeon control the robotic instruments from the robotic console a few metres away from the patient for a significant portion of the operation. Each robotic procedure involves a specialised team that is trained in robotic surgery. While Dr Bassin is controlling the robot and performing the robotic components of the procedure, his surgical assistant remains ‘scrubbed’ at the operating table beside the patient throughout the surgery. The rest of the team includes a cardiac aneasthetist, perfusionist to control the heart-lung machine and specialised robotic surgery nurses.
What is the recovery like?
The recovery after robotic heart and lung surgery is far more rapid than traditional surgery. This is due to much smaller incisions, less trauma and less blood loss, which results in less pain and inflammation which are common barriers to a smooth recovery. The trauma of open surgery can’t be underestimated and that is why recovery can usually take so long.
Following robotic heart surgery, you will wake up in intensive care later the same day. Small tubes to drain any residual fluid from around the heart will be placed in your neck, as well as intravenous lines, to sample blood and administer medications. These tubes and lines will be removed after 1-2 days and then you will be transferred to the ward to continue your recovery. Once on the ward, the goal is to monitor your blood pressure and heart rate and ensure adequate mobilisation. We work very closely with our nurses, physiotherapists and occupational therapists to work on breathing exercises and functional mobilisation. Every patient is different and the assistance is tailored to your needs. Patients who have undergone robotic surgery may leave the hospital after 3-4 days, however the patient should dictate when they feel ready to leave hospital.
Once home, patients who have robotic surgery continue to recover a lot faster than those who have undergone open heart surgery with splitting of the breastbone. Mobilisation is far easier and there aren’t any restrictions on lifting. Most patients will feel back to their usual selves after a few weeks following robotic surgery, compared with 3 months following traditional open heart surgery.
Patients who have undergone robotic lung surgery can often be discharged within 2 or 3 days following surgery with far reduced pain compared to traditional lung surgery.
What are the benefits and risks of Robotic Surgery?
The benefits of robotic heart and lung surgery are a far more rapid recovery with less pain and trauma than traditional open surgery. There is enhanced visualisation for the surgeon with 10x magnification and 3D depth perception which can enable more accurate surgery.
The risks of robotic heart surgery are similar to open heart surgery with a risk of death, stroke, infection, kidney injury and bleeding. There are some differences in the risk profile with robotic surgery with a reduced need for blood transfusion, reduced post-operative infections and no risk of a catastrophic sternal wound infection. For all robotic and minimally invasive surgery there is the risk that the operation may have to be converted to an open operation for a number of reasons including impaired visualisation or bleeding.
The major risks of robotic lung surgery include infection, bleeding and an air leak from the lung. Robotic lung surgery reduces the risk of these compared with open lung surgery and greatly reduces the risk of long term post-operative pain.
Dr Bassin will explain these risks to each patient in person and how they pertain to their specific condition.
Why should I consider this procedure?
Dr Bassin will recommend this procedure to patients who he thinks are suitable candidates. If you are deemed a good candidate you will be able to benefit from having heart or lung surgery without the pain and trauma usually associated with such major surgery. This will enable you to return to your everyday life, family, work commitments and other interests as soon as possible.