Technological Innovation Helps Patients Undergoing Coronary Artery Bypass Surgery Recover Much Faster With Less Pain
When doctors at Allegheny General Hospital (AGH) informed Joseph Scolero that heart bypass surgery could improve his health, the 73 year-old from Cranberry Township had complete faith in their expertise. Diagnosed with congestive heart failure 12 years ago, Scolero has become accustomed to following the advice of his medical team. Still, after watching his wife recover from two open heart surgeries, the idea of undergoing the same procedure at his age was more than a little unsettling. Fortunately, the doctors at AGH had something quite different in mind.
In March, Scolero became one of the first patients at AGH 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.
Currently the only program of its kind in western Pennsylvania, robotic heart surgery continues a long-legacy of pioneering advancements at AGH in the fields of cardiology and cardiovascular surgery. In the 1990s, cardiac surgeons at the hospital were among the nation’s first to perform the earliest generation of minimally invasive “keyhole” heart bypass procedures.
Over the past decade, AGH has also developed one of the state’s leading robotic surgery programs, providing patients with less invasive surgical options for a host of medical problems. Last July, the hospital’s kidney transplant team joined a short list of leading medical centers in the country using robotic surgery to less invasively remove kidneys from live donors, and its urologic and gynecologic surgeons have been longtime leaders in robotic assisted laparoscopic techniques.
“We are extremely excited and proud to introduce this new capability to our patients in the Pittsburgh region. The opportunity to combine Allegheny General’s advanced expertise in cardiac surgery with the latest in minimally invasive robotic surgical technology is a major step forward in the treatment of coronary artery disease and one that has proven to be of tremendous benefit to those who are good candidates for the procedure,” said AGH cardiothoracic surgeon Walter McGregor, MD, director of the hospital’s robotic cardiac surgery program.
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.
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 for bypassing of 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.
“A surgeon’s ability to safely and effectively harvest the internal mammary artery is absolutely critical to the success of coronary artery bypass surgery. Whereas with previous minimally invasive techniques this task was compromising, the robotic system affords a level of surgical precision that is unprecedented and actually improved over what we routinely achieve through the more invasive open chest approach,” Dr. McGregor said.
Dr. McGregor 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.
“We are fortunate to have forward thinking cardiologists at AGH who are interested in evolving coronary disease treatment. As our experience with minimally invasive heart surgery grows and the potential of this sophisticated robotic technology becomes better understood, the ideal indications for its use will continue to develop,” Dr. McGregor said.
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 mitigates complications associated with stopping the heart and using a heart-lung machine, including kidney failure and respiratory distress, Dr. McGregor said.
Scolero said the difference between his wife’s recovery from traditional open heart surgery and his experience with robotic surgery were remarkable.
“Two weeks after surgery I was already able to drive my car and just over a month later I was back to all of my normal activities. My heart was in such bad shape, I thought to myself, ‘what do I have to lose’ in being one of the first to have this new surgery. It turned out to be a great decision,” he said.