This technique has been limited to single bypass grafts in the left anterior descending coronary artery since it is located at the front of the heart and is therefore more easily accessible endoscopically. The robotic system is used to perform the entire procedure (including the coronary anastomosis) in a closed fashion without requiring the opening of the sternum or spreading of the ribs. It can also be performed "off pump," which means that it can be done on a beating heart without using the heart-lung machine. The advantages of the robot during heart surgery are said to be similar to other robotically assisted surgeries such as prostatectomies and include better dexterity, eliminating surgeon hand tremor, and enhanced visualizations.
Compared to the 6-8 inch incision made during open surgery and the 3-4 inch incisions made in traditional minimally invasive procedures, the robotic bypass procedure incisions are less than 2 inches long. Therefore, smaller incisions and avoiding cutting though the breastbone translates into smaller scars, decreased risk of infections, less bleeding, less trauma, and shorter hospital stay (2-5 days vs. 7-10 days). Recovery time after robotically assisted surgery is said to be shorter ranging from a few days to one week compared to 1 to 4 weeks for traditional minimally invasive surgery.
This technology is fairly new and the data described above is based on small studies and few surgeon experience. Some surgeons argue that there are no real advantages to the robot in bypass surgery and that the traditional way has shown to be successful over a long period of time. The quality of the coronary anastomosis is another concern. One study showed that the surgical limitations of the minimally invasive procedure are related to the inability to perform a conventional hand sewn coronary anastomosis and the limited space during surgery. Furthermore, they showed that more than 50 percent of patients experienced anastomotic stenoses or occlusions.
Another disadvantage is the cost of the robotic system and only hospitals that can offset the cost with their high volume can afford the technology.
In conclusion, robotic surgery has shown to be safe and effective in the hands of experienced surgeons. This has shown to be true in robotic prostatectomies for patients with prostate cancer where it has now become the standard of care. Robotic cardiac procedures are still new and advances in technique are needed in order to meet the standards in the field and it is likely to be several years before it becomes widely available and accepted.
David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site,