Many years ago, when writers wrote about a world where machines would assist humans in daily life, it was called science fiction. As the years went by, and technology advanced, so many things that were fiction turned into fact. As recent as twenty years ago, cardiac operations were a big deal, a ‘serious’ operation, and you would not have believed it if someone had told you machines would be doing the job much better in a few years.
But this is now true, and H.G.Wells is probably saying ‘I told you so’. One of the latest approaches to cardiac surgery involves a recent innovation that uses robotic instrumentation to allow cardiothoracic surgeons to operate through a smaller opening for a minimally invasive surgery. It’s called the da Vinci Surgical System.
For many heart patients, when medication and catheter-based treatments do not relieve the symptoms, surgery may be the only option for treatment. But just hearing about the procedures of traditional or open heart surgeries can make even the most stout-hearted among us to feel queasy. “First, your chest is cut open, then your breastbone is cracked open, then we reach in to your chest cavity…” you get the picture.
Thankfully, there have been major advances in surgical technology, which now brings to us minimally invasive surgery and unmanned surgery. Initially, the purpose of having a machine perform surgery was to facilitate remotely performed surgery in battlefields and other remote environments. But it was soon clear that the telesurgical robot was more useful for minimally invasive on-site surgery.
Robots as surgeons
Robotic surgery and research on this has been going on for some time. In 1988, the PROBOT was used to perform prostatic surgery. The ROBODOC was introduced in 1992 to ensure precise fittings in the thigh bone for hip replacement surgeries. These were the forefathers of the da Vinci Surgical System.
The da Vinci Surgical System provides surgeons and patients with the most effective, least invasive treatment alternative for even the most complex procedures, such as mitral valve repair. The best news for the patient who takes this option is that this process offers the potential for a better clinical outcome. Patients who choose this surgery have shorter recovery times than those who have open heart surgery.
How the da Vinci system works
In this process, instead of cutting open the chest, and parting the breastbone, a small working incision and three to five small incisions (ports) are made in the spaces between the ribs. The incisions are about the size of a fingertip. The surgical instruments (attached to the robotic arms) and one tiny camera are inserted through these ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the movement and placement of the surgical instruments to perform the procedure.
The spirits of the sci-fi writers and scientific visionaries need to put the brakes on their celebrations though – the da Vinci still needs a surgeon to be in control of the robot. The system is an extremely sophisticated tool that enables the surgeon to perform the surgery with greater precision and control as well as minimal invasion on the body.
Apart from the advantage that the body does not need to take a severe trauma for the procedure, the da Vinci system also gives surgeons the option of performing the surgery on a ‘beating heart,’ in which case the patient is not placed on the heart-lung bypass machine (this is called“off-pump” surgery).
The Process
During the Robotic cardiac surgery procedure, the surgeon sits in a console to the left of the da Vinci console. The robotic arms are directly above the patient, and function as an extension of the surgeon’s hands, directed through the controls in the console.
A tiny camera attached to a robotic arm gives the surgeon a very detailed, 3D view of the operating space inside the chest. The robotic arms are very agile, and so the surgeon gets a greater range of motion than is possible with hand-manipulated moves in standard procedures.
Benefits of Minimally Invasive Surgery
- Quicker return to normal activities: Rather than waiting several weeks to heal, patients can return to work or other activities much more quickly–usually within 10 days.
- Shorter hospital stay: Time spent in the hospital can sometimes be reduced by as much at 50 percent, compared to traditional procedures.
- No splitting of the breastbone (“cracking the chest”): Keeping the breastbone intact reduces the chance for post-surgical complications and infection.
- Smaller incisions: Depending upon the case, the operation may be performed through four to five fingertip-size incisions or through a 3- to 5-inch incision at the side of the chest. Traditional open-heart procedures demand a longer incision down the center of the chest.
- Much less pain: Decreased destruction to tissue and muscle results in less pain. Tylenol or aspirin are usually enough to manage pain after some procedures.
- Elimination of the heart-lung bypass machine: In most cases, avoiding the bypass machine decreases the risks for neurological complications and stroke.
- Minimal blood loss and less need for transfusion
- A reduced risk of infection
- Small scarring: Instead of a long chest scar, only a few tiny scars or a small, 3- to 5-inch scar remains.
Robotic heart surgery in India
Doctors at the Chettinad Health City, Chennai have successfully performed a rare robotic heart surgery on a 23- year-old patient. Dr. R. Ravi Kumar, the Director of the Institute of Cardiovascular Disease at the hospital, said that the robotically assisted procedure involved replacing both the mitral and the aortal valve simultaneously. Although the procedure is quite new in India, Dr. Ravi Kumar was positive about the system being used for a variety of procedures.
Just like for any successful surgery, minimally invasive procedures also need well qualified, trained hands. Since the procedure is very different from operating through a large chest incision, it requires doctors to be trained in a different manner. Even highly experienced surgeons must devote dozens of hours to learning how to use the techniques and equipment for minimally invasive surgery.
