Robotic assisted heart surgery: The new benchmark – ETHealthworld.com

In an exclusive interaction, Dr Sathyaki Nambala, Senior Consultant, Cardiac Thoracic and Vascular Surgeon, spoke to Prathiba Raju about the robotic assisted heart surgery and its benefits.

1. What are the clinical advantages for the surgeon and patients with the robotic heart surgery unit? The general misconception in robotic surgery is that a robot operates. But the truth is that a robot is only a tool, the surgeon operates using the robot. So, the hand movements are robotic, but the surgeon is the one that controls the hands. So it is as safe as any other surgery. Now, why would I want to do robotic surgery? If you have to operate inside the heart, you need to open the chest, cut open the bones, spread the chest wide open and then access structures. That is how traditional surgeries were being done and are still done. Now, the next step to traditional heart surgery was minimally invasive surgery where you made a small opening, a small cut usually about three to four inches and through that, use long instruments and do the same operation.

With traditional surgery, the major drawback is that, when you are opening, cutting the bone and disrupting the chest wall which causes a lot of pain, delay in recovery and has also got a psychological trauma to it. Some undergoing open-heart surgeries are very traumatic for the patient and the family, because of the pain they go through for two to three months during the recovery process. Sometimes, it takes a long time to recover for old patients, diabetic or obese patients. Functionally, they wont even heal, but the trauma in their mind and their functional capacity will never come to normal.

2. How is the functioning capacity of a patient who has undergone robotic heart surgery? The functional capacity is going to be better because you are not disrupting the chest wall and breaking any bones. You are going through 8mm ports and doing whatever was done by cutting open the bones. With a robot, the holes are only eight mm the maximum port size. You will make four or five or eight mm holes and through that, you will do the operation exactly like the way you would do it in traditional surgery. Of course, here, you have better vision, three-dimensional and high resolution. So, it is good for the patient because,

Importantly, in the robotic heart surgery unit, we are not doing an open by-pass heart procedure. This is still at its early stages and as of now, robotic bypass heart surgeries are performed only in one hospital in Chicago (US), as these advanced robotic tools are not available anywhere else.

I want to mention that robotic heart surgeries are not suitable for young children because the distance between the heart and the chest wall is very close. And we dont have enough room to operate. These instruments are long and we dont have short ones yet.

4. Does OT unit performing robotic heart surgeries need specialised training? It needs specialists, although performing a robotic heart surgery is just the same way as traditional open-heart surgery. In traditional methods, you are using your hands, and in robotic heart surgery, you are using the clinical robotic surgical system, which includes a camera arm and mechanical arms with surgical instruments. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site they are small and fine with better control.

5. How many procedures are done in the first robotic heart surgery unit in Apollo Hospital, located in Bengaluru? As of now, on an average, it is four procedures per week. Now, we dont want to do more; we dont want to rush. Mostly, ASD, VSD and multi-valve procedures like mitral-valve replacement/repair and tricuspid valve repair are done. Within a few months, we are looking upon to do at least two procedures per day. Initially, the expert team has to learn and understand and get experience, it takes time to develop that.

6. In India, there is a dearth of doctors, particularly surgeons. You had said we need specialists when we handle such robotic units. How important is it for cardiac surgeons, OT unit to learn about this new skill? It is extremely important because we are already talking about Artificial Intelligence (AI) and Machine Learning (ML), which were not there many years ago. As our understanding of machines improves, we need to learn to adapt the best way we could. Maybe 15 years from now only robots will operate, surgeons will be sitting to only monitor what the robot is doing. As technology evolves, machines will be doing some of these simpler operations. The number of people required to run would drastically come down. Currently, about two surgeons are running one OR (surgery centre), soon it can turn out to be a surgeon managing more two ORs during the robotic surgery. It could also be used in remote areas. It could be possible that one day, a surgeon is sitting in one console in a different city operating multiple operation centres across. These are all the future possibilities of a robotic surgery unit.

7. Right now, in this particular unit, how many people are needed in the operation theatre while performing? While performing, you need at least five to six people. In any heart surgery, you have a surgeon to do the operation, another surgeon/specialist who will assist the surgeon, a technical assistant, two nurses who will arrange for instruments as and when required, one more person to run the heart machine and one to give anaesthesia this is the minimum number required (about 6 people). For robotic surgery, it remains the same.

8. Usually, in robot-assisted mitral valve surgeries take a longer time than the traditional method? Is this true or why is it so? One should understand that robotic heart surgery is a new technique used by surgeons. In many cases, when they start a new procedure or technique or tool, the procedure takes longer than what could be done in the past. It takes time to gain experience and hence, takes longer. Over a course of time, if you do it repeatedly, the time taken for the surgery will come down drastically.

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Robotic assisted heart surgery: The new benchmark - ETHealthworld.com