Robotic Heart Surgery

What is robotic heart surgery?

Robotic heart surgery is a type of minimally invasive heart surgery in which a surgeon controls surgical tools attached to thin robotic arms. The surgeon doesn’t open your chest in the way they do for standard open heart surgery.

Robotic cardiac surgery has changed the way surgeons perform certain heart operations. It allows them to perform certain types of complex heart surgeries with smaller incisions. Surgeons perform many robot-assisted mitral valve surgeries. The most common cardiac operations that surgeons perform with the aid of a surgical robot are:

• Mitral valve repair.
• Closure of certain types of holes in the heart.
• Removal of benign cardiac growths or tumors.

Surgeons use a computer-enhanced robotic system that includes:

• A 3D view of the surgical area. The machine allows a surgeon to zoom in for a close view and see it in high resolution.
• Instruments on thin robotic arms that mimic the way human hands, wrists and fingers move. This allows for a wide range of motion and more precision.
• Controls that translate the surgeon’s natural hand and wrist movements into precise movement of the surgical tools.

How does robotic heart surgery work?

Your surgeon sits at a large console that looks similar to a video game. When they look into the machine, they see what the camera inside you sees. While the robotic arms are right next to you and over you, the surgeon isn’t. They control the machine’s robotic arms from the console in another part of the operating room, a few feet away from you. Other people from your surgical team are near you.

What does robotic cardiac surgery treat/manage?

Robotic heart surgeries include:

• Mitral valve repair.
• Mitral valve replacement.
• Septal myectomy.
• Tricuspid valve repair (with mitral valve repair).
• Atrial septal defect (ASD) repair.
• Patent foramen ovale (PFO) repair.
• Removal of cardiac tumors (myxoma, fibroelastoma of the mitral or tricuspid valve).
• Coronary artery bypass graft (CABG).

Who is a candidate for robotic cardiac surgery?

Healthcare providers perform diagnostic tests to determine if you’re a candidate for robotic heart surgery.

Tests may include:

• Cardiac catheterization.
• Chest X-ray.
• Echocardiogram.
• Computed tomography (CT) scan.

Your surgeon will review the results of these diagnostic tests to determine if you’re a candidate for robotic heart surgery. The type of treatment for your condition will depend on several factors, including:

• The type and severity of your heart disease.
• Findings on your cardiac catheterization, echocardiogram and CT scan.
• Your medical history.

How should I prepare for robotic heart surgery?

You can prepare for robotic heart surgery in these ways:

• Arrange for someone to drive you home after your provider discharges you.
• Ask your provider if there are certain medicines you shouldn’t take before your surgery. Only stop taking them if your provider tells you to.
• Stop using tobacco products several weeks before your operation so you can breathe and heal better after your operation. Avoiding tobacco products helps your wounds get the oxygen they need to heal.
• Stop eating and drinking at midnight before your surgery or at the time your provider tells you to stop.

What happens during robotic heart surgery?

The surgeon is always in control during the surgery. The robotic arms can’t move on their own.

A surgeon will:

1. Make four small incisions for ports in the spaces between your ribs. They often call the largest incision “the working port.”
2. Place the surgical tools (attached to the robotic arms) and one camera through these ports.
3. Sit at a computer console and use their hands to control the instruments. The robotic “arm and wrist” movements mimic those of the surgeon, yet they’re more precise.
4. Use their feet on foot pedals to control the camera, such as zooming in and out.
5. Remove all tools and close your incisions.

What happens after robotic cardiac surgery?

After robotic cardiac surgery:

• A provider will take you to an intensive care unit (ICU) after robotic heart surgery.
• You may stay in the hospital for several days, depending on your procedure.
• You may have a transthoracic echocardiogram (TTE) before going home.
• You may need two weeks or more for a full recovery.

Healthcare providers recommend taking your prescriptions and making lifestyle changes to maintain your heart health after surgery.

Lifestyle changes include:

• Avoiding the use of tobacco products.
• Managing high cholesterol.
• Managing high blood pressure and diabetes.
• Exercising regularly.
• Maintaining a weight that’s healthy for you.
• Eating a heart-healthy diet.
• Participating in a cardiac rehab program.
• Following up with your provider for regular visits.

What are the pros and cons of robotic heart surgery?

Like other surgeries, robotic heart surgery has its pros and cons.

What are the pros of robotic heart surgery?

Compared with traditional surgery, the benefits of robotic heart surgery may include:

• Smaller incisions with minimal scarring.
• Less pain.
• A shorter hospital stay (usually three to four days).
• Decreased use of pain medications.
• Less bleeding.
• Decreased risk of infection.
• Fewer complications.
• A shorter recovery and quicker return to daily and professional activities.

What are the cons of robotic heart surgery?

The cons of robotic heart surgery include:

• Longer surgical times than open heart surgery.
• A possible need to switch to open heart surgery (in less than 5% of mitral valve repair cases, 10% in robotic heart bypass surgery).

Any surgery has risks related to:

• Your age.
• Other medical conditions you have.
• The number of procedures you have during a single operation.

Your healthcare provider will discuss your risks before surgery. Ask questions to make sure you understand all of the potential risks.

What is the recovery time?

Most people can return to normal activities, drive and go back to work as soon as they feel up to it. This is usually within two to four weeks after surgery. You may need more time to recover from more complex surgeries.

Your provider will give you specific guidelines for your recovery and return to work, including specific instructions on activity and how to care for your incisions and general health after the surgery.

Depending on which robotic heart surgery you had, you may need to have regular echocardiograms.

How successful is robotic heart surgery?

Success rates vary by robotic procedure. Mitral valve repair rates are 93% and higher, with experienced centers reporting success rates approaching 100%.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

• Chest pain.
• Shortness of breath.
• Dizziness.
• Bleeding from your incisions.
• Redness around your incisions.
• Fever.
• Upset stomach.

A note from Cleveland Clinic

It’s good to remember that your surgeon — and not a robot — controls the robotic arms during robotic heart surgery. Because performing robotic heart surgery has a big learning curve, you may want to choose a hospital that does a large volume of this type of operation. Hospitals that do a lot of robotic heart surgeries perform them more often than those that handle a small number of them. Doing a large volume of surgeries allows surgeons to develop their expertise.