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Robotic Surgery at Nagpur in India

Robotic cardiac surgery is a rapidly growing phenomenon in minimally invasive heart surgery, as coronary surgeries can now be performed by robot arms with the aid of a tiny video camera. In this operation, three pencil-sized ports are standard. Through one port a tiny high-powered, voice-operated camera or endoscope is inserted and held by a robotic arm. Two robotic arms that control the surgical equipment are inserted in the other ports. The physician's role is to maneuver the camera through voice-operated controls and to manipulate the surgical equipment using a hand held joystick. Thus, the only surgical cut that a physician directly performs is the initial puncture of the chest.

What is Robotic cardiac surgery?

Robotic surgery for cardiac is a form of heart surgery performed through tiny incisions in the chest. The procedure is sometimes called da Vinci surgery because that is the name of the manufacturer of the robot often used for this procedure Robotic surgeries have been used for a number of different heart-related procedures, including mitral valve repair, coronary artery bypass, heart defect repair, and tumor removal.

Why Robotic Heart Surgery

We hope you never need heart surgery, but if you do it's important to know what options are available to you. This site provides 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. Minimally invasive techniques can be used for a variety of procedures, including coronary bypass surgery, mitral valve repair, and atrial septal defect (ASD or PFO) closure, or mitral valve replacement. Not everyone is a candidate for minimally invasive surgery.

Is robotic surgery better?

This is for you and your doctors to decide. However, I believe for that properly selected patient, it is superior. This is my personal opinion. In addition, there is great variation in the nature and quality "robotic heart surgery" procedures at different centers. To date, many clinical studies on robotic heart surgery have shown at least equivalent safety and clinical outcomes to traditional heart surgery. I think that one of the reasons it has not been proven superior yet is that so few centers do it well and those that do are very unlikely to want to switch back to large incisions to prove it. These issues are debatable and I encourage you to seek different opinions, because it is your life and your body. In the end, the most important goals of undergoing heart surgery are the same regardless of the approach: live through the experience and get the problem fixed! You and your surgeon should never compromise safety and effectiveness for small incisions.

Benefits of Robotic Heart Surgery

Minimally invasive surgery offers several advantages compared to open-chest procedures, including: -

  • Faster 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 open 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 require a longer incision down the center of the chest.
  • Significantly less pain. Decreased damage to tissue and muscle results in less pain. Tylenol or aspirin are often 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.
  • Little scarring. Instead of a long chest scar, only a few tiny scars or a short, 3- to 5-inch scar remains.

Robotic Heart Surgery procedure

Robotically assisted heart surgery is the latest advance in trying to move open-heart surgical procedures to the category of minimally invasive surgery - that is, to minimize the extent and the trauma of cardiac surgery as much as possible. Most minimally invasive surgery is performed by passing an endoscope (a small tube containing an advanced optical system) through a tiny incision. Surgical instruments are then passed either through the endoscope tube itself, or through an additional tiny incision. While visualizing the surgical area through the endoscope, the surgeon manipulates the surgical instruments to complete the operation. Such endoscopic surgery works well for several types of operations (such as gallbladder removal and knee repairs,) where the part of the body to be operated upon is motionless, and the surgical maneuvers that need to be performed are relatively simple. However, moving the surgical instruments manually during endoscopic surgery can be difficult - the length of the instruments is far longer than normal, and the "feel" of these long instruments is non-intuitive to the surgeon. Long instruments also exaggerate normal hand tremors. Thus, endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers tend to be complex.

Robotic heart surgery advantage and disadvantage

Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reduced duration of hospital stays, blood loss, transfusions, and use of pain medication. Additional surgical training is needed to operate the system. Numerous feasibility studies have been done to determine whether the purchases of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. Moreover, during the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction and regret.

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, and then gains access to the heart by splitting the sternum and spreading open the rib cage. The patient is then placed on a heart-lung machine and the heart is stopped for a period 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. 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. While the use of robotic surgery has become an item in the advertisement of medical services, critics point out that studies that indicate that long-term results are superior to those after laparoscopic surgery are lacking. The robotic system does not come cheap and has a learning curve. Data is absent that proves the increased costs can be justified. In medical literature, very experienced surgeons tend to publish their results with robotic systems. However, these may not be representative of surgeons with lesser experience.

Recovery from Heart Surgery:

The first phase of heart surgery recovery can last from six to eight weeks. When the person you are caring for leaves the hospital after heart surgery, you will most likely be given a set of instructions on care. Those who have had minimally invasive surgery may have a shorter recovery time. Sometimes self-care instructions are given directly to the patient.

Care of the Incision After Heart Surgery:

In order to take proper care of the incision after heart surgery, it is important to:

  • Keep the incision clean and dry.
  • Use only soap and water to cleanse the area.
  • Eat a healthy diet to help healing.

Call the doctor if signs of infection appear. These signs include:

  • Increased drainage or oozing from incision.
  • Opening of the incision line.
  • Redness or warmth around the incision.
  • Increased body temperature (greater than 100.4 F or 38 C).

You should also call the doctor if your loved one complains or notices that his or her sternum (breastbone) feels like it moves or if it pops or cracks with movement.

Pain Relief after Heart Surgery:

After heart surgery, some muscle or incision discomfort, itching, tightness, and/or numbness along the incision are normal. However, the pain should not be similar to what was experienced before surgery. Your loved one will be given a prescription for a pain medication before they leave the hospital. For bypass surgery, there may be more pain in the legs than around the chest incision if saphenous veins (leg veins) were used as grafts. Walking, daily activities, and time will help to lessen leg discomfort and stiffness.

Driving after Heart Surgery

Your loved one's doctor will tell him or her when they may resume driving after heart surgery. This usually occurs about 6-8 weeks after surgery; however, time may be shorter if he or she had minimally invasive surgery. During this time, they may be passengers as often as they like.

Activity after Heart Surgery

After heart surgery, the doctor will tell your loved one when he or she is able to return to daily activities. However, for the first 6-8 weeks, the following guidelines are generally recommended for patients recovering from heart surgery.

  • Gradually increase activity. Household chores can be done, but standing in one place longer than 15 minutes is not recommended.
  • No lifting objects more than 10 pounds.
  • No pushing or pulling heavy objects.
  • Unless restricted by doctor's orders, climbing stairs is allowed; however, climbing up and down stairs several times during the day, especially when the patient first arrives home, is not recommended. When planning activities, try to arrange them so the patient goes downstairs in the morning and back upstairs when it is time for bed.
  • Walk daily. Guidelines for walking will be given to the patient or the caregiver by the doctor or a cardiac rehabilitation specialist upon the patient's return home.