Coronary artery bypass grafting refers to a surgical treatment used for patients who have one or more coronary arteries blocked. This procedure involves grafting of a new blood vessel that bypasses the clogged artery and allows sufficient blood flow to the cardiac muscles.
There have been many improvements in terms of developing various approaches of minimally invasive surgeries and robotic-assisted procedure is one such milestone. It comes with various advantages. A normal traditional open-heart surgery involves cutting the chest and dividing the breast bone. It is known as the median sternotomy approach and demands a 10 – 12 inch incision through the sternal bone. However, the robotic procedure involves much smaller incisions between the ribs. Major incisions are avoided and it doesn’t involve cutting the sternum as a result of which the traumatic impact of the surgery is reduced in large number. This leads to less pain, faster recover, lesser blood loss during the procedure and lesser complications. It also allows the surgeon to have better view of the heart as opposed to a traditional surgery.
There are two main techniques used in this surgery –
Minimally-invasive direct coronary artery bypass: This technique is also known MIDCAB, it is a sort of a grafting which includes mammary artery graft that is dissected inside the chest. Using three pencil-sized incisions and later following the suturing of the mammary artery graft to the heart vessel with a 2-inch incision made between the ribs in the left chest. This procedure can also be done without putting the patient on a heart-lung machine and is therefore also referred to as the “off pump” procedure.
Totally endoscopic coronary artery bypass: This technique is also known as TRCAB, it is a sort of a grafting which includes entire procedure being done through three ports themselves and not requiring any additional incisions.
Any healthcare experts recommend a robotic cardiac surgery of there is an artery bypass procedure required to improve the blood flow to one’s heart. It is also recommended in cases where –
- The patient requires replacement or repair or there are leaky heart valves involved.
- In order to correct arterial fibrillation which is a common type of arrhythmia
- To treat congenital heart conditions
- There are other reasons for your surgeon to recommend cardiac surgery.
- There are signs of a tumour in the heart
In cases where there is a plaque build-up in the arteries and they get blocked, there are certain symptoms that point towards a surgery. Some of those symptoms include –
- Angina which refers to chest pain
- You constantly feel shortness of breath, especially after you do basic workout
- You can feel irregular heartbeat
- There are signs of fatigue and slight dizziness if you move around much.
One of the major reasons why people go for a robotic cardiac surgery and not an open-heart surgery is because it involves fewer risks. The less invasive nature of this procedure includes lesser complications. However there are a few risks involved such as –
- Heart attack
Preparing for surgery
In order to check if you are eligible for the surgery, your medical history along with your lifestyle is reviewed to understand the severity of the disease.
- You are given a consent form for permission and asks you to read instructions in case something is unclear.
- This is followed by a physical exam to check your health and understand the impact of the procedure on your body.
- You need to take special precautions if you are pregnant.
- You need to tell your healthcare provider in case you are allergic or sensitive to something like medicines, tape, contrast dyes, latex, iodine, anaesthetic agents etc.
- In case you are taking any other medicines or herbal supplements, you need to inform your healthcare provider.
- You need to inform your doctor if you have had a history of bleeding disorder or if you are taking blood thinners, or any other medicines that affect blood clotting. In most cases you are asked to stop taking these medicines before the procedure.
- You need to inform your doctor in case you already have a pacemaker or any such device implanted.
- In case of smokers, they are suggested to take a break from smoking as it helps in faster recovery.
- You are expected to stop drinking and eating at least 8 hours before the surgery.
This is the usual sequence of events that follows during a robotic cardiac surgery –
- You are given a sedative to help you relax before the procedure.
- You are placed under a general anaesthesia and given a breathing tube.
- Keyhole sized incisions are made on the side of your chest. These are in alignment with the openings right between your ribs.
- You are placed under a heart-lung machine for the procedure to begin.
- Depending on the type of procedure your surgeon goes ahead with, several precision-guided robotic arms are inserted into these incisions.
- They are holding and manipulating various tiny instruments to do the task on the heart or the arteries that surround it.
- The arms also insert a video camera inside to give a magnified three-dimensional view of the things inside. This allows the surgeon to get a better view of the operational site, and thus avoids any kind of mistakes.
- There is a console located within the operating room, using which the surgeon is able to control the robotic arms and the camera inside.
- Once the procedure is completed, the instruments and robotic arms are removed and incisions are closed.
Post the surgery, the patient is moved to the recovery area for proper monitoring. This is followed by a short hospital stay, which is shorter than what is followed by a traditional heart surgery. You are allowed to go back home once the pain subsides, your nausea is under control and your lab results are normal.
Robotic procedure leads to less scars on your chest. In most cases, an open heart surgery may leave a 10 inch scare, however a robotic cardiac surgery has fewer and smaller scars on the side of your chest.
You can manage the pain with over-the-counter medicines such as ibuprofen and acetaminophen. In robotic cardiac procedures, the pain also subsides quicker. One has to keep his/her incisions dry and clean. It is recommended to avoid usage of ointments, lotions or powders around the incision lines as it tends to irritate the skin and prolong the healing procedure. It also opens the wound to lot of infection.
A robotic cardiac surgery is less invasive and less risky in many ways. However, it is still important to pick the right healthcare provider for your surgery. It is a treatment option that heavily relies on technology and that is why picking state-of-the-art equipment is a necessity. Also it is important to go with a place like Max Healthcare, that is higher number of successful cases and doctors with lot of experience. The learning curve in this surgery especially is steep, which means, if done by wrong hands, the results can be disastrous. Right from good infrastructure to experienced hands – everything needs to be well thought of and chosen appropriately. Even picking surgeons that understand your needs individually and provide solutions, both during and post the treatment, accordingly.