Modesto hospital rolls out robotic-assisted surgery for heart patients. What makes it better?
c.jpg "Dr. John deGraft-Johnson with the Da Vinci robot")
Doctors Medical Center of Modesto is offering a minimally invasive option for coronary bypass surgery.
With the assistance of a surgical robot, Dr. John deGraft-Johnson operated on a patient in late June by making small incisions between the ribs and using the robotic arms to bypass multiple blocked arteries, most likely extending the man’s life for years.
The robotic-assisted operation is an alternative to cutting open a patient’s chest for open-heart surgery.
DeGraft-Johnson, a veteran surgeon, said for many patients, the prospect of cracking open the chest for the conventional surgery is terrifying, or at least sobering. The patient may spend five to six days in the hospital after surgery, followed by a recovery period of six to eight weeks while the breastbone heals.
Less pain and less blood loss are other advantages of the robotic-assisted operation.
“I am a pretty big guy and need to make a big incision to get my hands inside the chest,” said deGraft-Johnson, adding that he’s always open with patients about medical procedures.
With the robotic-assisted operation, the surgeon makes small incisions between the ribs to extend the robotic arms and a camera into the patient.
DeGraft-Johnson said he bypassed three coronary arteries for the first patient last month. The man went home in two days.
Surgeons at Doctors Medical Center have used the Da Vinci robotic surgery system for a range of general and specialized surgeries since 2007. One advantage is the greater range of motion of the small robotic instruments. On top of that, the magnification of the robotic system is greater than the naked eye.
Some hospitals are slower in adopting cardiac robotic surgery because of the costs of equipment and maintaining staff for the program. The rollout last month apparently is a reboot of services previously offered at Doctors of Modesto, which were more focused on mitral valve procedures.
Who are and aren’t good candidates for the technique?
The five-hour robotic-assisted surgery takes about the same time as the conventional open-heart operation. DeGraft-Johnson said he sees the minimally invasive technique as a good option for stronger patients with heart disease.
It may not be recommended for people with multiple health problems or complex heart disease. If the patient needs a valve repair in addition to bypass surgery, “in that case we are not there yet,” deGraft-Johnson said.
At University of Chicago Medicine, which does hundreds of robotic-assisted surgeries a year, a surgeon wrote in a 2020 blog that not all patients are candidates for robotic heart surgery. “Some patients who are seen as high risk, such as those who are obese, diabetic or who have had open-heart surgery in the past, may not be considered eligible for robotic heart surgery at most institutions.”
A 2015 study in the Journal of the American Medical Association concluded that robotic-assisted cardiac surgery was as safe as traditional surgery.
Dr. Dan Bettencourt, assistant clinical professor of surgery at Stanford University Medical School, said in a news release that the June surgery performed in Modesto was rare for the Central Valley region. He helped to launch robotic cardiac programs at Stanford and the University of California San Francisco.
In bringing the technology to Modesto, Doctors Medical Center said patients don’t have to travel outside the region to receive the state-of-the-art care.
Need for heart treatment in Central Valley
There were 1,945 coronary artery bypass surgeries in the Central Valley in 2021, according to the California Department of Health Care Access and Information. That was about 17% of all coronary bypass surgeries in the state. About 18% of Californians live in the Central Valley.
The Modesto hospital is a teaching facility with a residency agreement with UC Davis that includes a thoracic surgery rotation. Chief resident Sarah Chen extended her surgery rotation to take part in the multi-vessel robotic heart surgery last month.
“When it came time for the surgery, as a team, we were confident,” Chen said. “We sat down in advance and went over every detail of what to expect.”
DeGraft-Johnson said the hospital has a team of highly skilled professionals needed to operate a cardiac robotic surgery program.
“(The surgery last month) went exactly as planned, but I want to emphasize that it’s not just me,” deGraft-Johnson said. “It’s a team of highly trained and highly skilled professionals that genuinely care. The patient is doing remarkably well and, really, that’s why we do what we do.”
This story was originally published July 25, 2024 at 6:00 AM.
