Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011.
Robotic Cardiac Surgery 2018 · • Understand the value of Robotics in Cardiac Surgery • Know...
Transcript of Robotic Cardiac Surgery 2018 · • Understand the value of Robotics in Cardiac Surgery • Know...
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Robotic Cardiac Surgery 2018:
What Procedures Can a Dedicated Program Offer?
Husam H Balkhy MD
Professor of Surgery
Director Robotic and Minimally Invasive Cardiac Surgery
University of Chicago Medicine
Winter Workshop 2018
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Disclosure
• Proctor Intuitive Surgical
• Proctor: Atricure
• Proctor Liva Nova
• Avid practitioner of robotic cardiac surgery
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We’re in Athens!!
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Objectives
• Understand the value of Robotics in Cardiac Surgery
• Know the scope and depth of a fully committed and multifaceted
robotic cardiac surgical program.
• Understand the indications inclusion and exclusion criteria for various
cardiac robotic procedures
• See live examples of a wide range of robotic cardiac surgical
procedures
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Why would we want to use Robotics in Cardiac Surgery?
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da VinciTM System Coronary Bypass Post-op Patient
Sternotomy Coronary Bypass Post-op Patient
“Patients don’t like sternotomies”Delos Cosgrove, M.D.
STS 1996
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Most Cardiac Surgical procedures require much more dexterity and precision than can be afforded by traditional laparoscopic and thoracoscopic approaches
Why would we want to use Robotics in Cardiac Surgery?
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Endoscopic Surgery is Limited
-Unnatural operative feel -2-D vision
-Hands and instruments misaligned-Incisions very small, a few millimeters-Very limited dexterity inside patient -Long instruments -Hands/wrists outside patient -Fixed instrument tips inside patient
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Why Robotics?• Completely Endoscopic Surgery
• Least Invasive surgical approach
• 3D visualization and articulating instruments lead to enhanced precision
• Both Epicardial and Endocardial access to the heart
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Why Robotics?
PrecisionAccuracy and Safety
Enhanced Dexterity
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Robotic Procedures in 2018
• Intra cardiac procedures (Valves, AS, Myxoma etc..)
• Coronary Bypass (Totally Endoscopic)
• Atrial Fibrillation and other Ablation procedures
• Other:
– Pacer lead Placement/ Removal
– Pericardial Resection
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What Intra cardiac procedures can be performed Totally
Endoscopically with the Robot in 2018?
– Mitral valve repair
– Tricuspid valve repair
– Combined MV and TV repair
– ASD repair
– Atrial Myxoma
– Resection Ventricular septum (HOCM)
– Resection Fibroelastoma (Mitral/Aortic valve
– Cryo Maze
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Robotic Intra-cardiac Procedures
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Redo Robotic MV repair, TV, CryoMaze
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Robotic Endoscopic ASD Repair
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Robotic Endoscopic ASD Repair: Unroofed CS
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What procedures do we perform with the robot in 2018?
• Totally Endoscopic CABG (TECAB)
– Single vessel TECAB: (usually LIMA-LAD)
– Multi-vessel TECAB
• Bilateral IMA (LIMA and RIMA)
• Sequential LIMA
– Hybrid Revascularization
• PCI First
• TECAB First
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C-Port Distal anastomotic Device
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TECAB: Operative Setup
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TECAB: Operative Setup
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Multivessel Connector TECAB
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Robotic TECAB: Sequential LIMA D1-LAD
-LIMA > Diag - LAD-End to side first: Flex A-Side to side: S18 U clips
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Robotic TECAB: Sequential LIMA D1-LAD
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LIMA-LAD Patency: (mid term): 98.2%
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Robotic Endoscopic Release of Myocardial Bridge
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Combined Robotic MV TECAB?
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60 year old male with severe MR and tight prox LAD lesionUnderwent totally endoscopic complex MV repair and LIMA LAD via ports.Home in 3 daysBack to work in 10 days
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• “Best of both worlds”: (B)IMA + benefits of minimally invasive
• Expands minimally invasive CABG
• Expands PCI (e.g. protected LM)
• Angiographic confirmation of grafts
Hybrid Coronary Revascularization
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What Other procedures can be performed with the
robot in 2018?
Atrial Fibrillation surgery:
– Pulmonary vein isolation with Conduction Block testing
– LAA ligation
– Arrested heart Cryo Maze procedure
Other Epicardial Procedures:
– LV lead placement for Bi Ventricular pacing (intelligent CRT)
– Pericardial drainage and stripping (constrictive pericarditis)
– TMR?
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AF Ablation: Epicardial RF
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Hybrid AF ablation
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VT Ablation: LV Summit exposure
• Epicardial VT Ablation
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Mapping Guided CRT: Smart Resynchronization
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Lead Complications
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Totally Endoscopic BH Pericardiectomy
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How About the Aortic Valve?
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Robotic Assisted Aortic Valve surgery
• Leverages success
with Robotic MV
surgery
• Excellent view of
Aortic valve
• Ports one or two
interspaces higher
• Chitwood clamp
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Robotic AVR 3f
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Sutureless AVR
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Robotic Perceval AVR
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Adult Congenital Cardiac Surgery: Anomalous Left PV Drainage
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Post-operative length of stay
• Robotic TECAB: 2-3 days
• Robotic MV repair/ Port Access AVR: 3 days
• Robotic AF Ablation: 2 days
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Robotic Totally Endoscopic Beating Heart Coronary Bypass
(TECAB)Inclusion Criteria
• CAD involving the LAD, Diagonal, and
high Marginal branches of the
Circumflex coronary artery
• CAD involving the the proximal RCA
• Patients needing one or two IMA grafts
(single, double or triple bypass)
• Patients with 3 vessel coronary disease
as part of a ‘Hybrid Revascularization’
strategy
Exclusion Criteria
• Previous left lung surgery
• Severe COPD/ emphysema
• Severe scarring secondary to previous
sternotomy/ bypass surgery
• Cardiogenic Shock
• Very poor ventricular function
• Need for Emergency CABG surgery
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Robotic Mitral and Tricuspid Valve Surgery
Inclusion Criteria
• Myxomatous Mitral valve degeneration
causing severe mitral regurgitation
requiring simple or complex repair
• Patients with severe Mitral regurgitation
requiring Mitral valve replacement
• Patients with severe tricuspid valve
regurgitation
• Patients with Mitral valve disease and
single vessel CAD amenable to PCI
Exclusion Criteria
• Severe scarring from previous right
lung surgery
• Severe COPD/ emphysema
• Associated 3 vessel CAD
• Severe scarring secondary to previous
sternotomy/ bypass surgery
• Very poor ventricular function
• Need for Emergency surgery
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Conclusion:
• Adapting robotics can enhance minimally invasive cardiac surgery by
increasing dexterity and visualization to produce a truly MIS approach.
• Multiple intra and epi- cardiac procedures can be performed safely
and effectively enhancing outcomes and shortening recovery time.
• Increasing the number and variety of procedures performed allows the
team to become comfortable and facile with the system.
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The TEAM!
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Thank you