Surgical Robot Allows People with Multiple Blocked Heart Vessels to Have Minimally Invasive Bypass Surgery and a Faster Recovery
Patient Roger Suter went home from the hospital four days after robot-assisted heart bypass surgery.
With the use of a surgical robot, people can now have multiple-vessel heart bypass surgery performed in a minimally invasive way with only three tiny incisions ? each smaller than a dime. The University of Maryland Medical Center is the first hospital in Maryland, Delaware, Washington D.C., and Northern Virginia to perform minimally invasive, beating heart, multiple-vessel coronary artery bypass surgery with the assistance of a surgical robot. The medical center has acquired the most advanced robotic technology.
Bypass surgery is a new use for the system, which has been used in recent years to perform prostate cancer surgery. Surgeons at the University of Maryland Medical Center are using the robotic system both for cardiac and prostate cancer procedures.
"The robot enables us to perform heart bypass procedures, even the most complicated multiple-vessel bypass cases, with results equal to traditional, open heart surgery. But because robot-assisted surgery is done in a minimally invasive way, there are significant benefits for patients," says Robert S. Poston, Jr., M.D., a cardiac surgeon at the University of Maryland Medical Center and an assistant professor of surgery at the University of Maryland School of Medicine.
Robot-assisted bypass surgery enables patients to go home from the hospital within only a few days of surgery and rapidly resume their normal activities. They have much less discomfort following the surgery and a reduced risk of infection, according to Dr. Poston, who has used the robot to perform three coronary artery bypass surgeries as well as several other types of heart surgery.
Surgeons control the robotic arms of the system from a computer console in the operating room, which allows them to operate tiny instruments and a three-dimensional, high resolution camera placed inside the patient.
UMMC is one of the few hospitals in the country performing robot-assisted minimally invasive heart bypass surgery.
"The robotic system adds a new dimension of surgical precision because it gives us the ability to maneuver instruments beyond the natural range of motion of the human hand. Therefore, the technology enables us to perform a more complex set of movements compared to what we can do with traditional instruments used in minimally invasive procedures," says James F. Borin, M.D., a urologist and director of robotic surgery at the University of Maryland Medical Center who is also an assistant professor of surgery at the University of Maryland School of Medicine.
For coronary artery bypass surgery, the instruments and camera are placed in the patient?s chest through three tiny, dime-sized openings. The surgeon attaches a blood vessel (known as a graft) from another part of the body to the heart in order to bypass or go around an obstructed heart artery. These blocked arteries may cause chest pain or a heart attack by impairing the normal flow of blood which carries oxygen and nutrients to the heart.
Roger P. Suter, 58, of Pasadena, Md., was one of the first patients to undergo robot-assisted bypass surgery at the University of Maryland Medical Center, on September 27, 2006. He had the surgery to open two blocked arteries and went home from the hospital four days later.
The usual hospital stay after a traditional, "open" heart bypass procedure is about 6-7 days and it takes about 1-2 months at home until patients can feel well enough to resume their normal activities.
Mr. Suter works for a furniture company. He began feeling intermittent chest pains while at work in September, so he drove himself to a hospital emergency room. He was transferred to the University of Maryland Medical Center after being diagnosed with blockages in three arteries leading to his heart. His doctors decided that blockages in one of the arteries could be treated with balloon angioplasty and stents, but that the other two blocked arteries required surgery.
During the surgery, Dr. Poston removed two arteries from their normal position in Mr. Suter?s chest and sewed them to his heart to bypass the two blocked coronary arteries. Because Mr. Suter's heart remained beating during the procedure, complications sometimes associated with a heart-lung machine were avoided. And because no large incision was needed, Mr. Suter made a quick recovery and was able to go home on October 1.
Mr. Suter says the way he feels now, compared to how he felt before surgery, is like night and day. "I feel so much better now. I have much more energy and I haven?t felt this good in a long time. I can sure tell the difference now," says Mr. Suter.
Cardiac surgeon at the controls of the robotic surgery system.
One of the arteries used in Mr. Suter's bypass, the left internal mammary artery, is accessible with standard, minimally invasive laparoscopic techniques. Patients who need one vessel bypassed can often have the surgery using that vessel without a big incision. The bypass is performed with instruments that are passed through an opening in the left ribcage about the size of a keyhole. But Dr. Poston says when surgeons need to perform two or more bypasses, acquiring both the left and right internal mammary arteries is too complex for the standard laparoscopic techniques. That?s where the robot comes in.
"The robot is ideally suited to reach the right internal mammary artery because it can extend the tools and camera nearly a foot away from their points of entry in the chest, without tremor or loss of flexibility," says Dr. Poston. "Previously, we needed to perform open heart surgery to reach the right internal mammary artery." Open heart surgery increases the risks of infection and lengthens recovery.
Cardiac surgeons at the University of Maryland Medical Center prefer to use the internal mammary arteries for bypass grafting instead of using a vein from the leg. Unlike veins, the lining of these arteries is not prone to forming blood clots and they can withstand blood at high pressures, similar to the aorta or the coronary arteries.
"This is the beginning of a new era for patients who need cardiac surgery," says Dr. Poston. "The robot enables us to perform surgery with equivalent success compared to the standard procedures that require a large incision. But the difference in recovery time for our patients who need complex bypass procedures is dramatic, and that is most gratifying for us," says Dr. Poston.
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