Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

• Physical exam
• Blood tests
• Urine tests
• Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
• Coronary angiogram —a test to determine the extent and location of blockages of blood vessels supplying the heart muscle
• Chest x-ray
• Ultrasound —a test that uses sound waves to visualize structures inside of the chest
• CT scan —a type of x-ray that uses a computer to create images of structures inside the chest
• MRI scan —a test that uses powerful magnets and radiowaves to create images of structures inside of the chest
• Review your medications with the surgeon; you may need to stop taking some drugs.
• Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
• Follow a special diet, if recommended by your surgeon
• Take antibiotics, if prescribed by your doctor
• Shower the night before using antibacterial soap, if your doctor asks you to
• Arrange to have someone drive you to and from the procedure, and for help at home after your procedure
• Eat a light meal the night before, and do not eat or drink anything after midnight unless told otherwise by your doctor
• Plan to wear comfortable clothing on the day of your procedure

Anesthesia

General or local with sedation will be administered depending on the procedure.

Description of the Procedure

To begin a robot-assisted cardiac procedure, the surgeon cuts several small (approximately one-centimeter) “keyhole” openings in the spaces between the ribs.

The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of the heart and other internal organs on to a video screen for the surgeon to see. The endoscope is attached to one of three or four of the surgical system’s robotic arms. The other two or three arms hold other instruments such as dissectors, scissors, scalpels, or forceps. These instruments are able to grasp, cut, dissect, and suture structures during the operation.

While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified three-dimensional image of the inside of the chest. Another surgeon stays by the patient during the procedure, where he or she can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeon’s larger hand movements into smaller ones.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After Procedure

You will be moved to the intensive care unit, where your heart activity and breathing will be closely monitored.

How Long Will It Take?

Usually 1-4 hours, but this depends on the type of procedure being done.

Will It Hurt?

Anesthesia prevents pain during surgery. Patients typically experience some pain and soreness during recovery, but receive pain medication to relieve the discomfort.

Possible Complications

• Damage to neighboring organs or structures in the chest
• Infection
• Pneumonia
• Blood clots
• Bleeding
• High or low blood pressure
• Stroke
• Anesthesia-related problems
• Death

Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (e.g., traditional endoscopic or open-heart surgery)

Average Hospital Stay

Usually 2-3 days, but may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity.

Depending on your procedure, your doctor will likely advise you to:

• Take certain medications, including antibiotics
• Avoid certain medications
• Perform deep breathing and coughing exercises soon after the surgery to expand your lungs, and prevent infection and collapse
• Sit up and move around as soon as possible after surgery
• Wash the incisions with mild soap and water
• Limit certain activities, such as showering, bathing, driving, walking up stairs, lifting, and working, for a period of time
• Enroll in a cardiac rehabilitation program