Robot-Assisted Heart Surgery: What You Need To Know

What is robotic-assisted heart surgery?
Robotic-assisted heart surgery is a type of minimally invasive surgery performed by a cardiac surgeon who uses a computer to control surgical instruments on thin robotic arms. This technology allows surgeons to perform certain types of complex heart surgeries with smaller incisions and precise motion control. Robotic-assisted surgery may change the way certain heart surgeries are performed in the future.

How is robotic-assisted surgery performed?
First, three small incisions or "ports" are made in the spaces between the ribs. The surgical instruments (attached to the robotic arms) and two tiny cameras are placed through these ports. Motion sensors are attached to the robotic "wrist" so the surgeon can control the movement of the surgical instruments.

The surgeon sits at a computer console and looks through two lenses (one for each eye) that display images from the two tiny cameras placed inside the patient. The computer generates a clear, three-dimensional image of the surgical site for the surgeon to view. Foot pedals provide precise camera control, so the surgeon can instantly zoom in and out to change the surgical view.

The surgeonís hands control the movement and placement of the endoscopic instruments. The robotic "arm and wrist" movements mimic those of the surgeon, yet are possibly more precise than the surgeonís natural hand and wrist movements. The surgeon is always in control during the surgery; there is no chance that the robotic arms will move on their own.

Why is robotic-assisted surgery beneficial?
Potential benefits of robotic-assisted surgery include smaller incisions, shortened recovery time, decreased length of hospital stay, and improved patient comfort.

Other potential benefits of robotic-assisted surgery include:

These are possible benefits. However, there may be no additional benefits of robotic-assisted surgery for you as compared to a more traditional surgical technique.

Who is a candidate for this surgical technique?
Robotic-assisted surgery is not appropriate for everyone. Before surgery, all patients must have a cardiac catheterization and chest x-ray. An echocardiogram and/or a computed tomography scan also may be required to provide more information about the patientís condition. Based on the results of these tests and your specific medical condition, the surgeon will determine if you are a candidate.

What surgeries can be performed with robotic assistance?
At The Cleveland Clinic, the robotic-assisted surgical technique can be used in select patients during these surgical procedures:

Traditional CABG surgery involves: placing the patient on the heart-lung bypass machine to circulate oxygenated blood during surgery; creating a 6- to 8-inch incision through the sternum to view the heart; stopping the heart in order to stabilize the blood vessels; and then performing the bypass procedure.

Minimally invasive bypass surgery decreases the size of the incision to about 3 to 4 inches. Depending on the technique, the surgeon may choose to perform surgery on a "beating heart," while the patient is not placed on the heart-lung bypass machine (this is called "off-pump" surgery).

Robotic-assisted surgery is used in combination with traditional minimally invasive surgery to perform bypass surgery through much smaller incisions. The robotic arms are used to open the pericardum (sac that surrounds the heart) and to harvest the mammary artery (in the chest wall) through a small incision. Then, the surgeon uses the mammary artery to bypass the blocked artery through a small incision. In most cases, the sternum or breastbone does not need to be opened.

During a biventricular pacemaker implant for heart failure patients, the robotic-assisted technique can be used to place leads on the surface of the left ventricle. These leads are then attached to a biventricular pacemaker to "resynchronize" the heartbeat and improve heart failure symptoms.

In the treatment of paroxysmal atrial fibrillation, the robotic-assisted technique can be used to open the pericardium and place the catheter for ablation (energy is applied through the catheter to correct the abnormal heart rhythm).

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 5/1/2006

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