The Division of Cardiothoracic Surgery in the University of Colorado Department of Surgery continues to grow its robotic surgery program, allowing patients less pain and shortened recovery time.
To a list of robotic procedures that already includes mitral, tricuspid and arrhythmia surgery, the division recently added coronary artery bypass grafting (CABG), an operation that reroutes blood flow around narrowed or blocked coronary arteries, improving blood supply to the heart.
“It’s a great option for patients who have one- or two-vessel coronary disease,” says Jessica Rove, MD, who performs the procedures in partnership with Nicholas Teman, MD, associate professor of cardiothoracic surgery. “We avoid sternotomy and the heart-lung bypass machine. Patients have a small incision over their left chest and can go home in a shorter time. It can be combined with a staged stent if they have disease in other vessels.”
Avoiding the sternotomy — sawing through the breastbone to reach the heart and surrounding structures — is a big advantage when it comes to recovery, says Rove, associate professor of cardiothoracic surgery.
“One of the biggest drawbacks of a sternotomy is the restrictions afterward,” she says. “We tell patients they can't drive for at least four weeks, they can't lift anything greater than 10 pounds for the first month, and after that, it's a staged increase in activity in terms of lifting. Anytime we go between the ribs, as we do with the robotic CABG, we don't break any bones, so patients can return to their activity as they’re able.”
The robotic procedure, with its small incision, also means a shorter time in the hospital after the surgery — three and a half days, vs. six days for an open CABG surgery. Avoiding the heart-lung machine that patients receiving traditional surgery are attached to during the procedure is an advantage as well, Rove says.
“We don't need to cannulate any big vessels, either in the groin or the chest, to put them on the heart-lung machine, and it also spares them a lot of the fluid shifts that happen with going on the heart-lung machine,” she says. “Everybody goes to the ICU after a CABG for monitoring, but there's very little to do in the ICU when somebody hasn't been on cardiopulmonary bypass.”
During robotic CABG, the robot is used to mobilize the left internal mammary off the chest wall. The anastomosis — the joining of the sections of the artery surrounding the blockage — is done by hand.
“We have an instrument called a stabilizer, and we put it down on the heart to hold it a little more still, enough that we can sew,” Rove says. “Nick Teman and I do these surgeries together, so one of us will take down the artery, and one of us will sew it together. We want it to be perfect, and so far, we've had great results — people with chest pain don't have chest pain anymore. Coronary surgery is very satisfying in that way.”
Not everyone qualifies for the robotic procedure, Rove says — the ideal candidates are those needing only one or two arteries bypassed, though stenting is in some cases available as a hybrid procedure for those with blockages in other arteries.
“You have to be a candidate for it, in terms of the anatomy of the blockages in the blood vessels going to the heart,” Rove says. “We talk to more people about it than are actually candidates for it. A lot of people are interested in a minimally invasive procedure, but we are very thoughtful about it with our cardiologists or the patient’s referring cardiologist. We always want to come up with an individualized plan that makes sense for that person.”
Featured image: Cardiothoracic surgeons Joseph Cleveland, MD, and Jessica Rove, MD, at the controls of the DaVinci surgical robot.