When John Dodson of Pittsburgh was informed that he needed bypass surgery for a blocked artery, he assumed that the surgery would include having his chest cracked. The cardiac surgery team at Forbes Regional Hospital however informed him that open-heart surgery was not his only option.
In August, Dodson became the first patient at Forbes Regional to undergo robotically-assisted minimally invasive coronary artery bypass surgery. The groundbreaking procedure enables surgeons to perform single or multiple vessel revascularization with significantly less trauma and risk compared to the conventional open chest surgical approach.
The robotic heart surgery program at Forbes Regional is only the second to be established in the region alongside Allegheny General Hospital (AGH). Both Forbes and AGH are members of the West Penn Allegheny Health System.
“We are thrilled to introduce this exciting new capability to our patients as they no longer have to travel to the city to receive such cutting edge care,” said Forbes Regional cardiothoracic surgeon Michael Culig, MD, director of the hospital’s Heart and Vascular Center. “The opportunity to combine our program’s advanced expertise in cardiac surgery with the latest in minimally invasive robotic surgical technology is a major step forward that further distinguishes Forbes Regional as the leading center for cardiovascular care in the eastern region of Pittsburgh.”
With traditional coronary artery bypass surgery, surgeons access the heart through a long incision in the chest wall and a separation of the breastbone at the front of the ribcage. Robotic heart surgery is a closed-chest procedure that is performed using the da Vinci Surgical System, a state-of-the-art technology that allows surgeons to work on the heart through just a few small incisions.
“I have to admit, when Dr. Culig first mentioned robotic surgery to me as an option, I had hesitations,” said Dodson. However, he researched the procedure and saw that some of the country’s most prominent heart centers, like AGH, were utilizing robotics to advance heart surgery. After a discussion with Dr. Culig about the benefits of robotic surgery over the traditional, open-chest procedure, Dodson decided that this was the right approach for him.
Originally developed by NASA for operating remotely on astronauts in space and used by the Department of Defense to operate on soldiers in the battlefield, the da Vinci System is comprised of two primary components, a remote console that accommodates the surgeon and a five armed robot that is positioned at the patient’s side.
Sitting comfortably at the console several feet away from the operating room table, the surgeon maneuvers da Vinci's robotic arms and views the surgical field through a high resolution, three dimensional endoscopic camera mounted on one of them. The System seamlessly and precisely translates the surgeon’s natural hand, wrist and finger movements from controls at the console to the robotic surgical instruments inside the body.
With the assistance of a specialized surgical team stationed at the bedside, da Vinci’s robotic arm instruments are inserted into the patient through three half-inch incisions made between the ribs. Using hand controls and foot pedals to manipulate the robotic arms, the surgeon performs the delicate surgical tasks that allow bypassing blocked arteries in the heart with segments of a healthy vessel from the chest called the internal mammary artery. Unlike conventional open-heart surgery, the procedure is performed while the heart is still beating and does not require use of a heart lung machine.
Dr. Culig said the ideal candidate for robotic surgery is generally someone with single vessel disease or someone with multiple vessel disease who can be treated with a combination of surgery and coronary stent implantation – referred to as a hybrid therapeutic approach. The decision on which course of treatment to pursue is made by the surgeon in close consultation with the patient’s cardiologist.
The advantages of robotic heart surgery are considerable, including lower risk of infection, less scarring, shorter hospital stays, reduced blood loss and a quicker recovery. Beating heart bypass surgery also may mitigate complications associated with stopping the heart and using a heart-lung machine, including kidney failure and respiratory distress, Dr. Culig said.
Dodson said he was amazed by the relatively short recovery time. “I feel fantastic. I’m so happy that I chose this option; I feel as though I returned to normalcy so much faster than if I would have undergone traditional surgery,” he said.