Robotic Surgery: Cardiovascular Procedures
Robotic Cardiac Surgery
Robotics in cardiac surgery has enabled the surgeons perform surgery with smallest possible incisions. The robotic arms (Intuitive Endowrist®) have tiny joints that bend like a wrist and fingers, enabling the robot to operate like human hand.
Robotic surgery is performed without opening the chest. Access to the heart is achieved by introducing thin robotic arms via small incisions made between the ribs. The surgeon sits on a master console and controls the robotic arms with help of very sophisticated computerized motion controller. Surgeon has 3D high definition vision which is magnified 6 times. This enables surgeon to perform complex cutting and sewing with superior precision offering patient improved outcomes.
- Direct Coronary Bypass
- Mitral Valve Repair
- Totally Endoscopic Coronary Bypass
- Robotic Closure of ASD (hole in heart)
- Atrial Fibrillation Surgery
- Robotic Implantation of Heart Failure Devices
Lenox Hill Hospital’s robotic surgeons are some of the most experienced in the country. They have performed over 1,500 Minimally Invasive Direct Coronary Bypass procedures, the most in the country. The Chairman of the Department of Cardiothoracic Surgery pioneered this procedure in 1994. To view a complete list of publications on minimally invasive procedures, click here.
Learn more about Dr. Nirav Patel
Learn more about Dr. Valavanur Subramanian
Mitral Valve Repair Surgery
Mitral valve repair requires complex techniques to correct the diseased valve. The goal of mitral valve repair surgery is to achieve a normal functioning valve which would last a patient’s life span. Dr Patel at Lenox Hill Hospital is one of the handful surgeons who perform this procedure routinely.
The mitral valve is found near the back of the heart. It prevents the blood from flooding the lungs when the pumping chamber (left ventricle) pumps blood through the body. Mitral valve is made of two leaflets which are suspended by strings (chordae tendon). The mitral valve leaks when one of there string elongates or ruptures. Repair of the mitral valve provides best long term outcomes.
Traditionally surgeons have approached the mitral valve from the front of the chest through the breast bone and working around the right side of the heart to gain exposure to the mitral valve structures. Lenox Hill surgeons have significant experience using newer technologies to approach the mitral valve from right side of the chest using a minimally invasive 3 inch incision. Long shafted specialized instruments and the assistance of scopes and television monitors allows the surgeon to work in depth with direct exposure to the valve. The incision is on the right side of the chest at the level of nipple or underneath the breast in females. Majority of leaky mitral valves at Lenox Hill Hospital are repaired through minimally invasive methods.
Minimally Invasive Direct Coronary Artery Bypass
MIDCAB is done without the support of heart lung machine on a beating heart and performed through a 3 inch incision. The use of robot to harvest the internal mammary artery (artery below the breast bone) enables the surgeon to reduce the size of the incision and minimizes rib spreading. The use of the robot enables surgeons to reach the entire length of internal mammary artery. 3D high definition magnified vision makes precise harvesting of this artery even easier. The bypass is then performed using conventional instruments on the beating heart using specialized instruments to stabilize the heart.
Totally Endoscopic Coronary Artery Bypass
Totally endoscopic coronary bypass on a beating heart is the most minimally invasive bypass surgery. It is performed through four pencil holes using robotic instrumentation on beating heart. The patient has no large incisions or rib spreading. Specialized endoscopic instruments are used to perform bypass. The 6x magnified view in HD and 3D enables surgeon to perform precise suturing essential to a successful surgery. The recovery is very rapid and patients can return to normal life activities within days rather then weeks.
Lenox Hill Hospital surgeon Nirav Patel, MD is one of the few surgeons in the world performing this surgery on regular basis. LHH is the only program in north east performing TECAB on beating heart on regular basis.
Atrial Septal Defect Closure
About 4 to 8 % of the population is born with defect in the heart called an atrial septal defect, a hole in the partition of the receiving chambers of the heart. If the defect is not closed it can lead to permanent damage to the lungs. A small hole may be closed by using a catheter inserted into the patient’s groin. If the defect is larger, it will require surgical closure.
Robotic technology enables surgeons to fix the hole via a very small incisions on the right side of chest. This is done in cosmetically acceptable way in female patients (underneath the breast).
Lenox hill was one the few sites in the nation to participate in the pioneering trial which led to approval of robotic technology for closure of ASD.
Atrial Fibrillation Surgery
Atrial fibrillation is a condition of heart when the regular rhythm of the heart becomes irregular. It is caused by an enlargement of the receiving chamber of the heart called the atrium. Atrial fibrillation leads to stagnation of blood inside the heart, which leads to formation of clots that can cause paralysis or a stroke. This irregular beating also causes palpitations. This condition is treated with drugs to slow the heart rate and thin the blood. Long term use of these drugs leads to significant side effects.
Ablation is a procedure in which scars are made in the atrium using various energy sources to stop propagation of fast heart rate. Ablation could be performed through catheter by heart rhythm doctor from small puncture hole in the groin. However significant percentage of patients has recurrence after catheter ablation. Lenox HIll Hospital surgeons were the first in the world to perform robotic isolation of pulmonary veins for atrial fibrillation.
Implantation of Heart Failure Devices
Some patients have enlarged heart leading to loss of synchronization of heart beat. Pace makers are implanted to synchronize the heart beat and improve heart failure. In some patients the heart failure device cannot be implanted through the neck and these patients traditionally need large chest opening. The robotic technologies enables surgeons to implant the device through small pencil hole incisions.