The Johns Hopkins Division of Cardiac Surgery has recently initiated clinical use of a surgical robot to perform minimally-invasive cardiac surgical operations. Traditionally, cardiac surgery is performed through a sternotomy, a large incision extending down the center of the breastbone, providing access to the heart. The disfigurement and pain associated with this extensive incision has been a longstanding but necessary part of cardiac surgery.
We use the most technologically advanced surgical robotic system in the world. This system allows us to perform complex operations through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. There is evidence to suggest that, compared to patients undergoing standard open-chest cardiac operations, this minimally-invasive approach may translate into:
- less pain,
- better wound cosmesis,
- fewer wound complications,
- shorter hospital stays, and
- shorter recovery time.
The first robot-assisted cardiac operation at Johns Hopkins Hospital, performed in June 2003, consisted of successfully placing a biventricular pacemaker lead on a beating heart. Johns Hopkins is prepared to offer several carefully selected cardiac procedures to patients desiring a minimally-invasive approach. These operations include mitral valve repair, atrial septal defect closure, and biventricular epicardial pacing lead placement. Other robot-assisted cardiac procedures under development include coronary artery bypass surgery, transmyocardial revascularization, and ablative procedures for atrial fibrillation.
Robots in Surgery
The surgical robotic system is comprised of four principal components: a surgeon console, a computerized control system, two instrument "arms," and a fiberoptic camera. The surgeon sits at the console and views the heart in three-dimensions through the camera while manipulating the instinctive operating controls. The surgeon's hand motions are relayed to a computer processor, which digitizes and relays them to the fine instrument tips placed into the chest cavity through small 1 cm port incisions. This computerized robotic system enhances the surgeon's ability to perform minimally invasive cardiac surgery in several ways. The surgical robotic system permits the accurate translation of the surgeon's hand motions to a dexterous endoscopic "wrist" placed within the chest cavity, conferring much higher degrees of freedom and precision than could be achieved with traditional hand-operated instruments. In addition, the advanced two-camera stereoscopic optics provides unprecedented magnified, high-definition, full-color images of the heart and its structures in three-dimensions. This visualization provides much greater detail of the heart than is generally possible with the surgeon's eye.
Robotic Mitral Valve Repair
The robotic system for mitral valve repair is available at The Johns Hopkins Hospital. Mitral valve repair is one of the first cardiac surgical operations performed with the robot and for which FDA approval was obtained. The mitral valve can be accessed by a small 6 to 8 cm right thoracotomy and two 1 cm instrument ports. Excellent visualization of the mitral valve with the robotic camera system is usually obtained, greatly facilitating its repair. Posterior quadrangular resections and/or "sliding-plasty" repairs are generally performed.
If you are a patient with isolated mitral insufficiency who would like to be evaluated for this minimally invasive approach to mitral valve repair, ask your doctor for a referral to The Johns Hopkins Hospital. If you are a doctor and would like to discuss or refer a patient who may be a good candidate for robot-assisted mitral valve repair, please feel free to contact our offices directly at (410) 955-9780.
Robotics Research at Johns Hopkins
Johns Hopkins Hospital collaborates with the Johns Hopkins Departments of Mechanical Engineering and Computer Science, focusing on developing robotic sensory feedback capabilities. The research also seeks methods for training physicians and residents in the use of the system using mathematical modeling, which our surgeons hope will ultimately lead to improved surgical training techniques and better-trained robotic surgeons.