Robot - Assisted Heart Bypass with Cardiac Catheterization
On February 28, 2007, at 4 PM EST watch the premiere showing of a very unique surgical webcast from the University of Maryland Heart Center in Baltimore. See for yourself an operation called the HYBRID. This is an innovative approach to double or triple vessel coronary artery disease that combines minimally-invasive, robotic coronary artery bypass surgery with stented angioplasty, performed in just one operation. The University of Maryland Medical Center is among the first hospitals in the U.S. to offer this combined surgery, and is now the only Medical Center to offer this surgery with the use of robotic technology.
Cardiac surgeon, Dr. Robert Poston, an assistant professor of surgery at the University of Maryland School of Medicine, with the assistance of Dr. Charles Drummond, a clinical instructor at the University of Maryland School of Medicine, will use the daVinci-S surgical robot to harvest the left internal mammary artery, which will then be used to bypass the blockages in the heart.
Unlike traditional open surgery, there is no large incision made during this operation. Several tiny incisions, which measure smaller than the diameter of a dime, are made between the ribs so that the robotic instruments can be used inside the chest cavity.
While sitting at a computer console outside the actual operating room, Dr. Poston looks through lenses that provide a three-dimensional and highly magnified view of the inside of the body. He then uses wristed instruments to make very precise movements in the chest wall. Dr. Poston will harvest the left mammary artery and then through a two and half-inch incision in the chest, Dr. Poston will redirect one end of the artery to the heart surface and hand-sew the artery beyond the blockage, therefore increasing blood flow to the heart.
Once this bypass portion of the surgery is complete, Dr. David Zimrin, an assistant professor of medicine and director of cardiac catheterization, will perform angioplasty to restore normal blood flow in the remaining blocked arteries.
The hybrid takes place in an operating room that is both a fully equipped surgical suite and a state-of-the-art cardiac catheterization laboratory. This combined OR presents a tremendous advantage, because if for some reason doctors are unable to get a satisfactory result from the angioplasty side, they can convert to an open bypass operation. The patient won't have to be moved to another room because they will already be in a fully-equipped operating room.
There are many clear advantages to the patients who undergo the hybrid. It is convenient and less stressful to have bypass surgery and stenting performed at the same time and not two separate days. During this approach, the heart remains beating throughout. Because the heart-lung machine is never used to maintain circulation, it is safer and there are fewer side effects. Also, since all incisions are very small, the rate of recovery is much faster and patients can usually go home in two days.
Ideal candidates for the hybrid procedure have a blockage in a major vessel called the left anterior descending (LAD) artery, which supplies 60 percent of the blood to the heart, as well as blockages in non-LAD arteries that can be treated with a stent.