robotik-kalp-cerrahisi-004Many cardiac surgeries have been performed without opening the rib cage at our center since 2000. Up to date, 1014 patients have been operated by this method (minimal invasive).  

The first Robotic Cardiac Surgery in Turkey was performed by Prof. Dr. Belhhan Akpınar and his team at Florence Nightingale. Up to the present, 310 robotic cardiac surgeries have been performed successfully at the center. Our center has a capacity to provide foreign physicians with training about both minimal invasive and robotic heart surgeries.

Da Vinci Robotic Cardiac Surgery

What is Robotic Surgery?

With a Robot, the operations are possible to perform by making a smaller incision and without stopping the heart, providing the patients with many advantages for cosmetics or during the recovery period. The patients are able to recover faster after the surgery because no incision is made on the bones or muscles, and feel less pain because the wound is very small and the problems with the wound are largely avoided.

How is Robotic Surgery performed?

In the surgeries performed with a robot, the surgeon sits at the master console with a 3D imaging system which is located distant to the patient, and the arms of the robot (slave unit) in the chest move simultaneously with the hand moves of the surgeon to perform the surgery. Another surgeon at the patient is in charge of changing the surgical instruments the robot hold with arms, and of other operations. With the Da Vinci robotic system, the surgical instruments can perform any moves a human wrist can do in the thorax.

Who can undergo a robotic surgery?

Robotic surgery is mostly used in coronary bypass, mitral valve repair, and arrhythmia surgery. However, not everyone can undergo a robotic surgery. It is not used if the bypass surgery involves more than two vessels.

Cardiac Surgeries With Robotic Surgery

It has been slower and later for cardiac surgery to meet less invasive techniques that any other surgical fields. Such techniques are also slower to be accepted than the other techniques. This is because cardiac surgeons feel more comfortable with standard and classical techniques and because cardiac surgery has been possible to perform highly successfully using such standard techniques. But the developments in the percutaneous techniques (stent and balloon) and the resulting competition since 1990s have made surgeons perform the operations using less invasive methods.

The following graphic compares, by years, the coronary bypass (CABG) and percutaneous interventions (PTCA, stent) in the coronary revascularization in the USA. The inclination in favor of the stent is apparent here.
Conventional heart surgery uses a standard thoracic incision (median sternotomy) and heart-lung machine (HLM). Minimal invasive techniques attempt to eliminate the median sternotomy and/or HLM to make cardiac surgery less invasive.  

In median sternotomy cardiac surgery, it is the incision that provides control over a wide surgical area. However, it has several disadvantages such as damaging the chest integrity and longer time needed for recovery.

Despite successful use of endoscopic techniques in other fields of surgery, it has not found the expected place in cardiac surgery. The main reason for this is the two dimensional imaging systems and that the heart is on organ that works at all times. Despite the given difficulties, our clinic has performed endoscopic (port access) mitral valve, closure of ASD, and myxoma resection for more than 600 patients. As we have been acquainted with and experienced in such techniques, it was easier for us to switch to robotic technology.  

robotik-kalp-cerrahisi-002Robotic surgery provides many significant advantages. The image being three dimensional is an advantage for cardiac surgeons who are not used to work with two dimensional images. Furthermore, performing critical manipulations with long instruments through a restricted window causes shaking hands and tiredness. Robotic surgery eliminates this disadvantage too.

Although the early practices of robotic surgery in the world were related to the heart, the worldwide common developments have been in the urology (radical prostatectomy).
The average of 1700 cardiac robotic operations is performed each year in the USA. Around 400 operations are added to this number each year, increasing by 25% annually. The first robotic system in Turkey was set up at Florence Nightingale hospital in 2004 and has successfully operated over 300 patients to the present day.  

Surely, this figure will be increased by putting seven new systems into service in Turkey. It is widely used in mitral valve repairs and coronary artery surgery at our clinic as in the world. With the constantly developing technologies particularly the fourth arm and automatic mitral retractor recently developed, the operations have become easier to perform.

Advantages of Robotic Surgery

•    use of less blood
•    shorter hospital stay
•    less pain
•    low rate of infection
•    aesthetical superiority and getting back to work earlier.

What type of cardiac surgeries can the robot be used?

•    Repair and replacement of mitral valve
•    Coronary bypass (for one or two vessels)
•    Closure of ASD
•    Surgeries of arrhythmia
•    Cardiac tumors

If we ask whether robot technology is utilized in cardiac surgery sufficiently, it is not likely to give the answer “yes” to such question. Robotic heart surgery is still progressing. The centers, which have purchased this technology without necessary infrastructure and training, have experienced a profound disappointment. The experiences have showed that the clinics which fail to use the system multi-disciplinary have not achieved anything in the end. Use of the system in cardiac surgery with other disciplines, e.g. urology, general surgery, and gynecology, will reduce the cost and increase the potential of patients.

The number of robotic cardiac surgeries was increased by 25% in the USA in 2009. It is the same for our country and European Community members. While only one system was available in 2008, which was located at our service, now there are 15 units available Turkey wide.

Robotic surgery requires patience and difficult training. Being acquainted with OPCAB surgery and peripheral cannulation techniques and control over endoscopic systems are the essentials of this surgery. Once you are able to control these three items, the learning curve of robotic surgery will get higher faster. One of the most important factors for learning curve when to convert (conversion) to an open surgery. Conversion to an open surgery in MICS should never be considered a failure because nothing can be more important than the principle not to harm a patient.

From this principle, Group Florence Nightingale Hospitals have successfully performed robotic cardiac surgeries since 2004.