Gentle heart surgery with the DaVinci robot

Interview with Prof. Dr. med. Jürg Grünenfelder

Prof. Dr. med. Jürg Grünenfelder - Specialist Cardiac and Thoracic Vascular Surgery - HerzKlinik Hirslanden

The DaVinci surgical robot is mainly known from the field of prostate surgery. At HerzKlinik Hirslanden in Zurich, it has also been used successfully in cardiac surgery for years.

The "surgeon with four arms" does not tremble even once as he uses highly precise movements to remove part of the internal mammary artery, a small arterial branch in the chest cavity, for a bypass procedure. At the control console of the DaVinci surgical robot sits Prof. Dr. med. Jürg Grünenfelder, specialist in cardiac surgery and head of cardiac surgery at HerzKlinik Hirslanden in Zurich/Switzerland: "The robot can perform certain techniques better than a surgeon's hand.

The arms have a better freedom rotation than the human wrist. Any tremors are filtered out. And instead of standing bent over the patient for a long time, I sit at a comfortable workstation that prevents premature fatigue and can move two of the four robotic arms at a time.

All this with excellent visibility: one arm guides a camera with up to 10x magnification, the other three carry the necessary instruments." Prof. Grünenfelder and his team have been performing robot-assisted bypass operations at HerzKlinik Hirslanden for four years, and mitral valve reconstructions for 1.5 years.

Gentler heart operations thanks to DaVinci

The great advantage of using the surgical robot is the minimally invasive access to the chest cavity, explains Prof. Grünenfelder: "When we harvest a graft by hand, i.e. prepare a part of an artery that we want to use as a bypass, we have to spread the ribs by hand to have room for our movements. In the process, it can also happen that a rib breaks.

For the arms of the DaVinci, on the other hand, only tiny, approximately 1-centimeter-long incisions are needed in the space between the ribs." The fact that the ribs do not have to be spread during robot-assisted heart surgery significantly reduces the trauma to the chest. Patients suffer less pain after the procedure. Wound healing is also much faster. "It's a win-win situation for the patients and us cardiac surgeons," emphasizes Prof. Grünenfelder. "However, the robot never replaces the experience of the surgeon. The latter must master the techniques he performs with the help of the DaVinci. This is the only way to achieve good results."

The gentler procedure is ultimately also what puts the costs for the use of the expensive surgical robot back into perspective, according to heart surgeon Grünenfelder: "Even if the pure surgical costs are higher with the DaVinci, these are saved post-operatively by a rapid recovery and low complication rates".

Robotics technology continues to gain ground

Until now, the DaVinci has only been used for surgical procedures in which the heart has to stand still, i.e. using the heart-lung machine. The heart surgeons at the Hirslanden Clinic have slowly moved on to the more difficult cases. "After the bypass operations, we have now reconstructed about 30 mitral valves with the DaVinci. Double valve operations are possible, but still the exception," says heart specialist Grünenfelder.

He assumes that the further development of the DaVinci will progress rapidly: "The manufacturing companies are already working on inserting the robotic arms through only one access (single port) instead of four incisions in the future. This would again significantly reduce the burden on the patient." The first use of a DaVinci surgical robot with a single port could take place in urology or visceral surgery as early as next year.

If this method works, robot-assisted surgery for mitral valve reconstruction could become the standard procedure in two to three years, hopes Prof. Grünenfelder. Mitral valve insufficiency often remains undetected. The diagnosis is usually made when an unusual heart murmur is detected during the annual check-up with the family doctor. If the disease remains untreated over a longer period of time, it can become noticeable through reduced performance, impaired heart function, atrial fibrillation or an enlarged heart. People aged 60 and over are usually affected.

(Text source: Susanne Amrhein from PRIMO MEDICO)