• Robot-Assisted Cardiac Procedures

    Definition

    A doctor guides robotic arms to do surgery on the heart. The surgery is done through several tiny keyhole incisions.

    Reasons for Procedure

    Robot-assisted cardiac procedures are done to treat a variety of conditions:
      Robot-assisted mitral valve repair may be used to treat:
      • Stenosis (narrowing) of the mitral valve
      • Regurgitation (leakage) of the mitral valve
      Robot-assisted coronary artery bypass grafting (CABG) may be used to treat:
      • Blockages in the heart’s arteries
      • Severe chest pain ( angina ) that has not improved with medicines
    • Robot-assisted atrial septal defect repair may be used to treat a hole between the upper chambers of the heart that does not close properly during fetal development.
    • Robot-assisted biventricular pacemaker lead placement may be used to treat heart failure due to atrial fibrillation (irregular heart rhythm in the upper chambers of the heart).
    Pacemaker Placement
    Pacemaker
    Pacemaker leads implanted in heart to maintain normal rhythm.
    Copyright © Nucleus Medical Media, Inc.
    Benefits of robot-assisted cardiac procedures may include:
    • Increased range of motion with the robotic arms
    • Ability to filter out human hand tremor and translate the doctor’s larger hand movements into smaller ones
    • Reduced trauma to the body
    • Shorter hospital stay
    • Faster recovery

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a robot-assisted cardiac procedure, your doctor will review a list of possible complications, which may include:
    • Damage to neighboring organs or structures in the chest
    • Infection
    • Bleeding
    • Blood clots
    • Anesthesia-related problems
    • Death
    Some factors that may increase the risk of complications include:
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Depending on the reason for your surgery, your doctor may do the following:
    • Physical exam
    • Blood and urine tests
    • Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
    • Coronary angiogram —a test to determine the extent and location of blockages of blood vessels supplying the heart muscle
    • Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
    • Ultrasound —a test that uses sound waves to visualize structures inside the chest
    • CT scan —a type of x-ray that uses a computer to create images of structures inside the chest
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the chest
    Leading up to the procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, such as:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • Take antibiotics if instructed.
    • Follow a special diet if instructed.
    • Shower the night before using antibacterial soap if instructed.
    • Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
    • Eat a light meal the night before. Do not eat or drink anything after midnight.

    Anesthesia

    There are two options for anesthesia:
    • General anesthesia —blocks pain and keeps you asleep through the surgery
    • Local anesthesia with sedation—just the area that is being operated on is numbed, given as an injection

    Description of the Procedure

    The doctor will cut several keyhole openings in the spaces between the ribs. Next, the doctor will pass a small camera through one of the incisions. This small camera is called an endoscope. It will light, magnify, and project an image of the organs onto a monitor. The endoscope will be attached to one of the robotic arms. The other arms will hold instruments for grasping, cutting, dissecting, and suturing. These may include:
    • Forceps
    • Scissors
    • Dissectors
    • Scalpels
    While sitting at a console near the operating table, the doctor will look through lenses. He will see magnified 3D images of the inside of the chest. Another doctor will stay by the operating table and adjust the camera and instruments. The console will have joystick hand controls and foot pedals. Using these, the doctor will guide the robotic arms and instruments. After the instruments are removed, incisions will be closed with sutures or staples.

    Immediately After Procedure

    After the procedure, you will be:
    • Moved to the intensive care unit (ICU)
    • Closely monitored
    • Encouraged to sit up and move around soon after surgery

    How Long Will It Take?

    Usually 1-4 hours (depending on the procedure)

    How Much Will It Hurt?

    You will have pain and soreness during recovery. Ask your doctor about pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is dependent on the procedure you had done. Your doctor may need to keep you longer if you have any problems.

    Post-procedure Care

    When you return home, do the following to help ensure a smooth recovery:
    • Follow your doctor's guidelines on taking medicine. You may need to take antibiotics.
    • Do deep breathing and coughing exercises.
    • Follow a special diet.
    • Wash the incisions with mild soap and water.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Limit certain activities (eg, driving, strenuous activity).
    • Enroll in a cardiac rehabilitation program.
    • Be sure to follow your doctor's instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
    • Cough, shortness of breath, or chest pain
    • Difficulty urinating, such as pain, burning, urgency, frequency, or bleeding
    • Severe nausea or vomiting
    • Rapid weight gain
    • Pain and/or swelling in your feet, calves, or legs
    • Headache, feeling faint or dizzy
    • Other worrisome symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    About minimally invasive and robotic cardiac surgery. Columbia University Medical Center, Department of Surgery website. Available at: http://www.columbiasurgery.org/pat/mirobotic/procedures.html . Accessed September 14, 2009.

    Atrial septic defect repair. Inova Health System website. Available at: http://inova.org/inovapublic.srt/heart/pediatric%5Fservices/cardiac%5Fsurgery/atrial%5Fseptal%5Fdefect.html . Accessed July 27, 2006.

    Cardiac applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/patientresources/conditions/cardiac/index.aspx . Accessed September 14, 2009.

    Computer-assisted surgery: an update. Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/405%5Fcomputer.html . Accessed June 20, 2006.

    Mitral valve repair. Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/patientinformation/valvesurgery/mitralvalverepair/ . Accessed July 27, 2006.

    Robot-assisted heart surgery: what you need to know. Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3000/3044.asp?index=10728 . Accessed July 27, 2006.

    Robots lend a helping hand to surgeons. Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2002/302%5Fbots.html . Accessed June 20, 2006.

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