Considering a Robotically Assisted Approach for Heart Surgery? What Should You Ask Your Surgeon?

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Marc Gillinov, MD:

I'm Marc Gillinov, and I'm Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic, and my special area of interest is in robotic heart valve surgery, specifically robotic mitral valve surgery. Many patients want to have robotic surgery because it's a smaller incision and a much quicker recovery. We often hear a great deal of questions about robotic surgery.

One question is, do all surgeons do robotic mitral valve or robotic heart surgery? And the answer is no. It's almost a subspecialty within cardiac surgery. It requires additional training, generally a fellowship of a year beyond standard multi-year cardiac surgery training, and thereafter, it requires that the surgeon be in a program that has a high volume. Because this is a skill that really needs to be maintained by using it every week, every couple of days.

To become proficient with the robot, after training, there's still a learning curve, and that generally runs something like 50 to 100 cases. We're very fortunate here at Cleveland Clinic that we've done well over 2000 cases of robotic mitral valve surgery, so that means that we are well beyond our learning curve, although always striving for excellence if not perfection.

If you're told you need mitral valve surgery or mitral valve surgery with another procedure, and you are thinking about robotic surgery, you need to ask the surgeon a few questions. I mean, the first question is, am I a candidate for robotic surgery? Meaning, is this an operation that can be done with the robot such that you fix my heart just as well, but you slip in there with small incisions and quicker recovery. Not all procedures can be performed with a surgical robot. The surgical robot is an incredibly sophisticated high-tech tool, but like any tool, it has to match the job that needs to be done.

If you are a candidate for robotic surgery, then the next question is, who should do it? And of course, you don't want to force your surgeon into doing something that he or she is uncomfortable doing, so you need to find somebody with expertise. And of course, you can go to our website, Cleveland Clinic, other websites and see which centers have surgical teams - and it really has to be a team - have surgical teams that do robotic surgery, that have a lot of experience with great results.

Many patients travel for this surgery because again, it is extremely specialized. And it's certainly worth your while to determine whether or not you're a candidate for surgery, and then to decide where I should go for my surgery based on the experience, the expertise, and the results of the surgeons that you are considering.

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