Advances In Minimally Invasive Cardiac Surgery

 Research in robotic surgery may make open heart surgery less invasive by cutting down on the need for surgeons to totally open the chest.

It is now possible to do heart bypass and other types of heart surgery by making three small incisions in the chest and using robotic technology to work on the heart, according to Niloo M. Edwards, MD, vice chairman and director of cardiac transplantation at New York-Presbyterian Hospital. While not mainstream yet, the first robotic surgery was performed at New York-Presbyterian in January 2002. Such robotic procedures are only available now in FDA studies, but Dr Edwards predicts that the surgery may be only several years away.

“This technology has made a dramatic difference in having to open the chest,” said Dr Edwards who spoke at a  Medical Town Meeting, “What’s New in Cardiac Surgery,” sponsored by Danbury Hospital. Dr Edwards’ Danbury presentation, in which he discussed the three top technological breakthroughs in heart surgery, was arranged by David Copen, MD, chief of cardiology at Danbury Hospital.

The computer-generated robotic movements help eliminate small tremors from surgeons’ hands, making the surgery more precise, Dr Edwards said. Robotic technology also reduces the incision size and improves the magnification during the operation.

Technological advances in harvesting the leg veins that are used in bypass surgery have also made that procedure less invasive. Surgeons can now harvest veins endoscopically, by making several small incisions in the leg and using an endoscope, a lighted tube and camera.

Previously, surgeons needed to make a long incision, which was uncomfortable to patients and required a longer recovery time. “Endoscopic vein harvesting is the most beneficial new technology,” said Dr Edwards.

A new procedure is also helping heart patients who suffer from atrial fibrillation, a disorganization of the heart’s electrical conduction system. Atrial fibrillation is a disorder found in about two million Americans in which the heart's two small upper chambers (the atria) quiver instead of beat effectively.

The “Maze” procedure is a surgical intervention that treats atrial fibrillation by interrupting the circular electrical patterns that are responsible for this arrhythmia. Surgeons make strategic incisions in the heart, which help the heart get back on track.

The Maze operation, named for the mazelike incisions that surgeons make, is effective in about 90 percent of patients, according to Dr Edwards.

“There has been a tremendous amount of new technology that is making a dramatic difference in heart surgery.”