A Review of Robotics in Heart Surgery

Robotic surgery systems offer a consistent and precise platform for reproduceable operations. Research has found that these technologies not only assist the surgeon but can improve patient outcomes as well. In the realm of cardiology, robotics-assisted surgery has become popular for its lack of invasiveness. These procedures offer an alternative to the traditional open-heart surgery, sparing patients of the splitting of their breastbone and greatly reducing recovery time. In this article, we take a deeper look at robotic surgery and how it has impacted cardiovascular operations.

What is Robotic Surgery?

The term “robotic surgery” is often viewed as an autonomous robot completing the procedure without human interaction, however this is not the case. Robotics-assisted surgical systems are guided by professional, certified surgeons to facilitate the procedure being conducted. One can think of the robot as an extension of the doctor, who controls the robotic arms that enter the patient through small incisions.

“Each of these arms has a camera at the end that sends images to a video monitor or console to help guide the surgeons,” said Dr. Pavan Atluri, a cardiac surgeon and director of Penn’s Minimally Invasive and Robotic Cardiac Surgery Program, in a Q&A.

What Procedures Have Been Done?

Among the most common robotics-assisted cardiac surgeries is the mitral valve operation. This valve is located between the two left chambers of the heart, and gives rise to issues if it allows blood to leak between the chambers or if it becomes stiff and prevents proper blood flow through the heart. Depending on the severity of the condition, a patient may require either mitral valve repair or replacement.

These operations are can be done through several methods. Thoracoscopic surgery is a common approach in which a surgeon operates using tools guided by a camera through small incisions. Catheter-guided procedures are another applicable technique. This involves catheter insertion into a vein of the thigh, following this vein to the heart, then operating on the valve. A third option is minimally invasive robotic surgery, which has been conducted successfully using the da Vinci Surgical System. The first robotics-assisted mitral valve repair was done with this system in 1998.

A more invasive operation, the coronary artery bypass, can also be performed using the da Vinci technology. This procedure is done when a blockage in the coronary artery prevents a segment of the heart from receiving blood flow and aims to divert blood flow around this blockage using a graft. The open-heart operation is commonly performed for this surgery; however, thoracoscopy and robotic systems provide a minimally invasive alternative.

Removal of tumors inside the heart and the repairing of holes caused by atrial septal defect closure has also been done using robotic systems, as per the The Korean Journal of Thoracic and Cardiovascular Surgery.

What are the Benefits of Robotics-Assisted Surgery?

One benefit to using robotics in minimally invasive procedures is the size of the incision. The open-heart approach typically requires a 6-8-inch incision in the center of the patient’s chest, which leaves considerable scarring. In addition, the sternotomy associated with this approach requires the splitting of the breastbone in half, which makes open-heart procedures result in long recovery times. Minimally invasive robotic surgery allows patients to resume normal activity in a matter of weeks, greatly easing the recovery process.

Going Forward with Robotics

Robotic surgery systems are proliferating rapidly as of recent, and the Food and Drug Administration (FDA) is clearing more each year. Just last month, a team of bioengineers from Boston Children’s Hospital created a robotic catheter that can navigate independently inside the body. This robotic catheter was programmed to maneuver along the walls of an animal heart with no human guidance in a model of cardiac valve repair. This is the first documented study in which a robot successfully self-navigated through the body, aiming to assist in a procedure that repairs replacement heart valves that have begun leaking (paravalvular aortic leak closure). Once the robotic catheter self-navigated to the exact location of the leak, a cardiac surgeon took over to properly seal the leak.

Sources: Penn Medicine, da Vinci by Intuitive