5 Questions to Ask If You Are Considering Robotic Valve Surgery

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Marc Gillinov, MD:

I'm Mark Gillinov, the Chairman of Cardiac Surgery at  Cleveland Clinic.

Tarek Malas, MD:

And I'm Tarek Malas. I'm a cardiac surgeon here at Cleveland Clinic.

Marc Gillinov, MD:

Together we are the key components of the robotic team. We both do robotic heart surgery. If you are contemplating robotic heart surgery, there are five key questions that you should consider and that you should ask. The first one is fairly simple. The first question is this, is robotic surgery better for me than regular heart surgery through a sternotomy? Most often the answer is, yes. Robotic surgery is better for you because with small incisions, you're going to recover more quickly, you won't look like you had heart surgery, and you're going to feel better much faster than you would if you had a standard sternal incision. Why? Because in the robotic operation, we go through the side with small incisions and we do not cut any bones.

Tarek Malas, MD:

The second question about robotic surgery to ask is, am I a candidate for robotic surgery? That's a question that we examine together in a multidisciplinary team, meaning we work together with cardiologists, anesthesiologists, et cetera, to evaluate whether you are a candidate. We do a CT scan and certain testing procedures to evaluate if you are a candidate.

Marc Gillinov, MD:

The third question you should ask your surgeon concerning robotic heart surgery is this, can you do the same thing with the robot as you would through a regular incision? Meaning you don't want somebody to cut corners and give you a lesser operation just so you can get a smaller incision. We are selective, and we have great expertise after more than 2000 robotic operations, such that we know when we can do exactly the same thing through a small incision to speed the recovery. So the answer has to be yes, the surgeon can do the same thing with the small robotic incisions as a sternotomy. When that answer is yes, the answer to the whole question, should I have robotic surgery is obvious. Yes, you should.

Tarek Malas, MD:

The next important question to ask is how do you choose your heart surgeon? This is a very important question to ask. It's important to go to a center that has a lot of expertise and a lot of volume and surgeons who have performed this procedure many times. As you know, robotic surgery is not something that is taught at medical school. This takes a lot of expertise and time to develop, and it's important to go to a center that has done quite a lot like the Cleveland Clinic. We've done more than 2,400 cases and we have done them very well with a repair rate of about 99.8%. We've mastered the learning curve here to make the surgery a routine surgery, and we've worked together effectively as a team and performed the surgery in a fantastic, very structured way.

Marc Gillinov, MD:

The final question is really one just of curiosity. How do you do it? How does the robot work? Many people think it's sort of like a Keurig coffee maker where you hit a button and you come back and the coffee's made. Unfortunately, for the surgeon, it's not like that. There's no button that makes the robot repair your mitral valve or close the atrial septal defect. It is used most commonly, the robot, to repair the mitral valve, and it is a tool. It's an extremely advanced resilient tool. The most important part of it is a camera. Because we put a camera into the chest, we don't need an incision or a hole as big as my hand because my hand never goes in the chest. The camera is a three-dimensional camera, which enables the surgeon, Dr. Malas or myself sitting at a console to see inside your heart with three-dimensional visualization.

Then we can use three instruments at once. The instruments are long tubes, a little bit thicker than a straw, and they go into the chest through little ports. Although we only have two hands, we can have three instruments and a camera operating at once, us controlling them from the console. Then we use these instruments, which are scissors and forceps, just like regular instruments, we use them to repair your valve, and with the excellent camera and these very flexible instruments, we can do everything through tiny incisions such that the day after surgery, you don't look like you had heart surgery.

Tarek Malas, MD:

What to expect with robotic surgery compared to standard sternotomy? The sternotomy procedure takes much longer time to recover. The breastbone takes months to recover, in general, about six weeks what we say, but if you do a surgery in a robotic way, the recovery is much faster and it's much better. We don't break any bones during the procedure. Your recovery period is about three to four days in the hospital, and as soon as you're out of the hospital and you're out of pain medications, you can drive and go back to your daily life and go back to your job as well, if that's something that you want to do.

Announcer:

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