Article Type : Letter to the Editor
Authors : Mitra M
Keywords : Cardiac; Heart; Robot; Surgery; Robotic cardiovascular surgery
In
a robotic cardiovascular surgery; most likely cardiac surgeon’s specialization
will be in treatment of heart valve disorders, atrial fibrillation coronary
artery disease, and other cardiac diseases. Advantages of robotic
cardiovascular surgery are less invasive methods to reduce pain, disability,
and recovery time. Some robotic heart surgeries are performed without use of
heart-lung bypass machine, hence minimizing risk of stroke and other
neurological complications. Few medical robotic cardiovascular surgeries are
reviewed.
Although having steep learning curves and added cost involved
for mitral valve repair for robotic surgery and fact is that common
heart operations are performed using robot aided surgery. The
robotic process for mitral valve surgery took 224 minutes.
Robotic method for mitral valve surgery had similar outcomes
comparatively with conventional approach except that there were
half number of onward discharges to further care 7% to 15% and
one day less spent in hospital. Since all the cases were reviewed
after surgery had taken place, findings cannot establish cause and
caution. Advantages and disadvantages to each of the techniques
resulted to authors to conclude: “From a patient perceptive, all
techniques provide better outcomes, hence patient preference and
surgeon experience should dictate the method for mitral valve
surgery” [1-2].
This study depicts patients with multi-vessel coronary disease
including obstruction of the left anterior descending coronary
artery, the main artery in front of the heart. Robotic surgery
encompasses making three small incisions, each about 1 cm (1/2
inch) long in the left side of the patient’s chest. To view a 3-
dimensional scope with 10x magnification was included in the
middle port with robotic right and left arms in other ports. The
mechanical system has a powerful computer interface that allows
surgeons to sit at the console with full vision of the operative
field. Surgeon’s as usual surgical hand movements are rendered
through the tiny robotic arms inside the patient. Robotic arms
with identical instruments at their tips, precisely follow surgeon’s
hand movements [3-4].
Figures 1a): Left ventricle chamber measurement in the parasternal long-axis view [3].
Figures 1b): Color doppler demonstrating central aortic regurgitation [3].
Figures 1c): Tricuspid regurgitant jet evident on color Doppler imaging [3].
Figures 1d): Peak velocity of the tricuspid regurgitant jet (used to estimate pulmonary artery systolic
pressure) – this is unable to be adequately
detected in approximately 30% of patients undergoing echocardiography [3].
Figures 2: Illustrates Soft Robotic
Heart Graphs [6].
Figure 3: Illustrates 4D cardiac electromechanical activation imaging [8]
Figure 4: An
Implantable Extracardiac Soft Robotic Device
for the Failing Heart
Mechanical Coupling and Synchronization [10].
A potentially lethal bacterial disease of heart that
often affects heart’s tricuspid
valve, frequently resulting
permanent tissue damage.
But a reconstructive method in which valve can be repaired
with a bio scaffold on which new tissue can nurture and can give some patients a new hope of life. Dr. Guy is one of
only about a dodecahedral of cardiovascular surgeon in the United States who performed
complete valve repair procedures. He became one of the first surgeon
to perform reconstruction endoscopically using robotic
methods. Dr. Guy performed a robotic
repair by first removing nearly all damaged valve from the patient’s heart, later he then used ‘cylinder technique’ to repair
the damaged tissue with a sheet of bio scaffolding that had
been shaped into the tube. The cylinder
duct effectively served
as a new valve. Dr. Guy explained bio scaffolds consist of sheets
of ECM – an acellular
meshwork of fibers and carbohydrate polymers that enables reconstruction by giving patient’s own
cells a framework to build a new
tissue. Because ECM is made of natural
materials, sooner or later it is replaced by patient’s own cells and absorbed by the body. It also
has low likelihood of rejection since
it doesn’t contain foreign cells or proteins that could precipitate immune response [5].
Scientists at University of Minnesota effectively performed robotic
surgery to deliver stem cell treatment to damaged heart. Cells were effectively transplanted in six of seven cases. Successive Magnetic Resonance Imaging
(MRI) studies demonstrated that cells took hold in the heart and function
improved. They used a combination of skeletal myoblasts that give rise to muscle and bone marrow derived cells. Both cell types demonstrated to recover the development of new blood
vessels and recover function of injured heart muscle. It is worth to take note that human clinical trials
were successful. Skeletal and bone marrow cells that were injected
into damaged tissue revealed
to recover function in the left ventricle, the chamber of the heart that pumps into the aorta, the
main artery of the heart though which
oxygen – rich blood flows from the heart to the body [6-7].
The aim of research was to create safe and coronary
surgery, a lifesaving procedure
in which blood vessels from chest are used to route blood around blocked
sections of heart arteries. In traditional
bypass surgery, chest cavity is cut open and bones are “spread” requiring a lengthy and often painful
recovery for patients. The robotics bypass surgery
leaves the patient with only tiny
scars and are much faster and less painful recovery time. The robotic surgery required making three
small holes in the chest. Endoscopic surgery
uses two surgical
instruments and a tiny camera and light combination. In Penn
State procedure, a separate robotic
arm holds each of the two instruments and camera light assembly. At that time, US Food and Drug Administration allowed Penn State team to operate only one clogged artery in each bypass patient
using its robotic system [8-9].