Minimal Invasive Heart Surgery

The benefits of minimally invasive surgery have led to a new era in surgical technology enabling surgeons to perform surgery in a manner never before experienced. By placing robotic technology between the surgeon and patient, the da Vinci Surgical System can be used to perform minimally invasive cardiotomy procedure. The da Vinci Surgical System seamlessly translates surgeon's natural hand movements into corresponding micro-movements of the instruments positioned inside the patient.

The da Vinci Surgical System is changing the face of cardiac surgery is changing the face of cardiac surgery. In addition, patients are becoming more accepting of a less invasive approach as their experience is marked by decreased postoperative pain, quicker recovery times, faster return to functionality, and improve cosmesis. With US FDA clearance in cardiotomy surgery, the da Vinci system will provide value in large scale management of patients with heart disease.

At the Bangkok Heart Hospital, a comprehensive da Vinci cardiac surgery robotics program will enable our surgeons to perform better surgery while providing patients with the benefits of a minimally invasive approach.

Benefits of da Vinci Cardiac Surgery

Mitral value repair No sternotomy Optimal Visualization and exposure of the mitral valve and subvalvular structures Superior dexterity of instrumentation within the valve annulus Less intubation time Short lenth of stay

Atrial septal defect repair No sternotomy Totally endoscopic approach to ASD repair Less intubation time

Multi-vessel CABG with small thoracotomy Bilateral IMA Harvesting Mini left thoracotomy Non robotic multivessel grafting Off-Pump or On-Pump CABG Faster patient recovery

picardial lead placement No sternotomy Precise placement of left ventricular lead for Biventricular pacing Not limited by anatomical constraints Promotes hybrid therapy

Overall patient Benefits : Less intubation time Less post operative pain Less risk of infection Less blood loss and transfusions Less scarring and improved cosmesis Shorter hospital stay Faster recovery and return to normal daily activities

Featured Case da Vinci Robotic Mitral Valve Repair

Outpatient Procedure Background Minimally invasive mitral valve (MV) repair with home discharge within one day is the ultimate goal for robotically assisted surgery. We evaluated our da Vinci Surgical System robotically assisted MV repair experience towards achieving this goal. Methods All procedures were performed with peripheral cardiopulmonary bypass (CPB), transthoracic aortic cross clamp and antegrade cardioplegia. Three ports and a 4 cm intercostal incision in the right chest were used for access. All patients had posterior leafler resection and ring annuloplasty. The entire repair and all knot tying were performed robotically Results Between October 2001 and July 2002, 22 patients (18 men) underwent robotic MV repair. The mean age was 54 yrs (range 37-810. There were no incisional conversions, deaths, strokes or re-op for bleeding, 19 of 22 patients were extubated in the OR. Overall mean study times: Procedure 193 min (range 160-287). CPB 124 min (range 95-186) and cross-clamp 86 min (range 66-143). 8 patients were discharged in less than 24 hrs with average stay of 2.6 days. Comparing the first 10 to the last 12 there was significant reduction of times: procedure 210 vs. 179 min, CPB 137 vs. 113 min and cross-clamp 98 vs. 76 min. LOS from 4.2 to 1.25 days. Five patients had post-op a-fib. Three patients (14%) required readmission (2 a-fib, 1 cellulitis) within 30 days of surgery. Conclusion Complex mitral valve repair can be successfully performed with the da Vinci Surgical System. Currently, the majority of patients can be safely discharged within 30 hours.

da Vinci Surgical Procedures

Cardiac Procedures  Mitral Valve Repair Mitral Valve Replacement ASD closure Bilateral IMA Harvesting

Thoracic Procedures Bilateral IMA Harvesting Epicardial Leads Application Pericardial Window Esophagectomy Thymectomy Lobectomy Wedge Resection Mediastinal Tumor Removal Heller Myotomy Other Esophageal Mass Enucleation Sympathectomy PDA Ligation