Robotic Heart Surgery

Up to the present time, coronary bypass surgery has always been a thorough and potentially dangerous operation. It involves a trip to ICU, and months of rehab and recovery time. Of course, gallbladder removals used to not be so trivial either, before they developed an endoscopic technique. Through endoscopic procedures, patients’ recovery time is much less and there is virtually no visible scar. Now, even heart surgeries are being done in a minimally invasive manner in some institutions.

Normally, endoscopic procedures are trickier for a surgeon than an open one because he is using longer instruments that are more foreign to him and harder to control, and the increased length exaggerates hand tremors. When dealing with a moving system like the heart, these tremors and difficulties make the surgery impossible to perform safely through a scope. The robotic surgery however, uses the aid of computers. The surgeon performs the operation with his hands at the computer, akin to a video game, and the computer interprets his hand motions and performs them in the patient’s body with precise controlled movements. This eliminates the tremor effect, and makes a minimally invasive coronary surgery not only possible, but possibly safer even than the original method.

The benefits to such a procedure are very high, including a much reduced recovery time and rehab program, because the sternum is not cracked open. Also, the thoracic cavity is never opened to the outside world, so infection is virtually impossible. Early results have been very good. However, there are objections to the idea. For starters, each machine runs close to a million bucks, and many hospitals cannot afford such an expense when their current methods already work. Also, if something were to go wrong in the surgery, would it even be possible to fix it in time without the heart exposed and easily accessible. When a surgeon misses his mark in an endoscopic ACL repair, he can just redo it. You don’t have those liberties when dealing with the heart. Plus, do we really want to trust a machine that can’t think or feel with the lives of our loved ones. Using mechanical means just incorporates more variables into an already tricky procedure. There could possibly be a system failure or programming error. What if the power were to go off? How would one respond to a failure with a system he is not familiar with?

All of these are questions facing this industry as it moves forward. It definitely has promising benefits, but at what cost? Cardiac surgeons would be reinvented; how would they adjust? At any rate, it will be interesting to see if and when robotic surgery passes traditional open methods for coronary bypasses as the method of choice, and what else could evolve from here.

http://heartdisease.about.com/library/weekly/aa060401a.htm