Coronary artery bypass operations, using a surgical robot, can result in less pain and faster healing for the patient. But the advanced service is offered in few communities across the country.
Dr. Goya Raikar performed three surgeries last week to launch a robotic heart program at Doctors Medical Center in Modesto. Two patients underwent coronary bypass operations and a third had a heart valve repair to relieve troubling symptoms.
Doctors is now one of the few hospitals in California, where a robot can play a crucial role in operations on the heart.
“There is no doubt the recovery time is faster,” Raikar said. “And there is less risk of blood loss.”
The first patients were faring well at the time of an interview Tuesday.
The use of minimally invasive robotic surgical systems exploded in the health care field over the past 10 to 15 years. Doctors Medical Center made an investment in surgical robotics in 2007 and many urological, gynecological and general surgeries at the hospital are done today with a robotic assist.
Robotics in heart surgery, however, is mostly limited to some research institutions and university medical centers in the United States. In California, where the famed da Vinci surgical system originated, cardiac programs at UCLA and University of Southern California are among the few examples.
Doctors of Modesto cares for heart patients from a six-county region and has surgeons who are trained to perform robotic heart procedures. A da Vinci Surgical System has been dedicated to the hospital’s cardiac services.
“To offer this high level of heart care to our community is something we are very proud of,” Chief Executive Officer Warren Kirk said. “This level of expertise is rare for a community hospital and a tremendous benefit to our patients.”
With robotic surgery, the machines do not perform the operations. Rather, a specially trained surgeon sits at a high-tech console, which provides a 3-dimensional image of the heart, and works the master controls to make incisions and cut and suture tissue that appears in the monitor.
The system is connected to the four-armed robot, which stands at the operating table and holds an endoscopic camera and flexible rods with surgical tools at the tips. The instruments are inserted through small portals opened in the patient’s body. The surgeon’s hand movements at the console are interpreted and translated to the surgical tools at work inside the patient’s body.
Surgeons like Raikar have a sharper view of the patient’s anatomy and a greater range of motion for working with tissue. If necessary, the robotic-assisted surgeon can bring in a third hand for a more complicated procedure.
Since conventional open-heart surgery involves cutting through the sternum and cracking open the patient’s chest, it’s easy to see that robotic procedures done through small incisions in the chest are less invasive, though they are more complicated. During a traditional bypass surgery, a heart-lung machine takes over the functions of the vital organs while the surgeon operates on the heart.
Raikar said robotic bypass surgery is performed on a beating heart.
The first two patients in Modesto who underwent coronary artery bypasses were in the hospital for 1 1/2 and 3 1/2 days. That’s compared with the normal five to six days with conventional bypass surgery.
Raikar, who is fellowship trained and has more than 12 years of robotic surgery experience, said there is less trauma for the patients. He especially sees a difference at the clinical visit three weeks after the surgery. The patients look better compared to those who have had open-heart surgery, which may require several months for recovery.
Raikar firmly contends that robotics are the superior technology for mitral valve repairs. With the robot, Raikar opens a portal on the right side of the patient’s chest, giving the surgeon a straight, gun barrel view of the leaking valve.
Raikar said he often recommends valve repair, over valve replacement, because of the high success rates.
One study, cited by the American College of Cardiology, reported a 99.5 percent survival rate after five years among 487 patients who had robotic mitral valve repair at a medical center from 2008 to 2015.
Raikar said he expects other heart surgeons at Doctors will train on the system and it could be used for 10 to 20 surgeries a month. The system can also assist with heart defect repair or tumor removal.
Dr. T. Sloane Guy, director of minimally invasive cardiac surgery at Thomas Jefferson University Hospital in Philadelphia, said there are not many cardiac robotic surgery programs at private hospitals, because of the effort required to establish and maintain a high-volume, quality program.
“The surgeons must be adequately trained and the hospital needs to provide the support to grow and sustain the program,” said Guy, a member of the Surgeon’s Council for the American College of Cardiology. He co-chairs a thoracic surgeons task force on robotics.
“The dark side of minimally invasive surgery and robotics happens if a surgeon or hospital staff fails to get the necessary training and education,” Guy said. “It can be more dangerous than regular surgery when people are not prepared.”
Guy said it can be easier to launch a robotic program at a private hospital than a university center, because the staff at private hospitals are more streamlined when it comes to teamwork. At private community hospitals, staff members tend to work with the same people every day in the same department, he said.
Raikar received training in cardiothoracic surgery at the University of Wisconsin Hospital and the Mayo Graduate School of Medicine in Rochester, Minn. According to a biography, he performed the first robot-assisted mitral valve operation in Minnesota.
The surgeon said the Modesto program couldn’t be launched without the heart team at Doctors. During the operations, another surgeon is at the operating table to adjust the camera if needed and assist in other ways; the team in the operating room also includes an anesthesiologist, two nurses and technicians.
“He says a simple something and I know to follow through with that,” said Dr. Michael Sasevich, a cardiothoracic surgeon at Doctors who works with Raikar. The robotics program is a huge leap forward for the hospital, he said.
During the recent mitral valve operation, Raikar put a stitch through the heart and relied on Sasevich to tie it.
Raikar said he assures patients that if he can’t see well enough during the operation or runs into a serious issue, the team is set up to convert immediately to the standard open-heart procedure.