Professor Tristan Yan has been appointed as the clinical lead of the Minimally Invasive and Robotic Cardiothoracic Surgery Program at RPAH. He has performed more than 1000 minimally invasive cardiothoracic procedures with excellent clinical outcomes. To enhance the RPAH Minimally Invasive Cardiothoracic Surgical Program, Professor Martin Misfeld, the co-director of Leipzig Heart Centre (Europe’s largest cardiac centre) was also appointed a
There has been tremendous evolution and innovation in cardiac surgery. In the early years of the specialty, innovation focused on decreasing mortality and expanding the pathologies that surgeons could address during heart operations, while in the current era, with operative mortality for routine procedures exceedingly low, the focus has shifted to decreasing perioperative complications, improving perioperative quality of life, and maximizing long-term outcomes. As a result, the onus has fallen on surgeons to shift away from the traditional sternotomy (a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided) and offer equally effective operations through less invasive approaches.
“Mitral valve surgery is one area that has seen some of the most impressive progress over the last two decades. With the advent of new technology, including peripheral cannulation systems, specially designed instruments, and robotic-assistance, complex valve repair and replacement can now be performed through small access incisions in the right chest without disturbing the skeleton. Minimally invasive surgical approaches offer patients gold standard results with fewer complications and a faster recovery, ensuring that despite the growth of transcatheter technologies, patients and cardiologists will not have to make the choice of trading long-term efficacy for short-term gains”, said Professor Misfeld.
One of the research projects currently under investigation is examining the advantages of minimally invasive surgery including less bleeding, enhanced cosmesis, shorter ICU and hospital length of stay, better respiratory function, less transfusion requirements, less infectious complications and faster return to work. The project also analyses the possible complications and the reasons for the robotic approach not gaining widespread use, which may include the complexity of procedure, and the cost associated with greater initial investment, maintenance, disposable instruments and retrograde cardioplegia catheters. In the study, it has been suggested that this may be compensated for by the overall economic advantages of a robotic approach, specifically shorter hospital stay and faster return to work. The available literature has clearly shown that the costs associated with robotic-assisted mitral valve surgery are in no way prohibitive. The potentially increased costs relative to traditional approaches are easily offset by the many advantages of the evolving technology.
Given the present cost-conscious healthcare climate, the appraisal of the economics of robotic surgery, supported by The Baird Institute will only intensify and, as adoption broadens and more surgeons become facile with the technique, the balance will likely continue to move in favour of this impressive technology. Future robotic mitral operations will be customized for each patient and will be based on their valve pathology, comorbidities, fragility, and age as well as their surgeon’s ability. The less invasive era in cardiac surgery is here, we need to keep an open mind and adapt to change!
