Tip:
Highlight text to annotate it
X
[ Silence ]
>> The history also perhaps started somewhat in the late 1990s in cardiac surgery
with the advent of minimally invasive port access surgery,
application of that in cardiothoracic surgery.
That kind of opened up the whole field of minimally invasive,
small access for cardiac surgery.
Then the robotic application in surgery, in general, and cardiac surgery, in particular,
became a big enabler for surgeons to do complex operations, having various degrees of freedom
that he can do the operations the way that you are accustomed to.
And then gradually, with the field of visualization
of the tissue becoming more bifocal, and then you have better depth of vision,
also enabled the surgeons to do more operations.
For the application of robot in coronary vascularization, there is an artery
that runs behind the sternum, behind the breastbone right in here.
So you can come from the left side of the chest with three little ports and be able
to see the entire length of the artery, and separate it from the chest wall.
And then make a small incision underneath one of the ribs that is closest on the artery
on the heart, and then just bring the artery down and anastomose it
to the area that you were going to bypass.
For the application of the mitral valve, the exposure is usually from the right side,
that actually, we make an incision between the ribs on the right side, again,
somewhere between an inch and a half to two inches long.
And then we will put the patient on the heart/lung machine
through a small incision on the groin.
For thoracic operations on the lung, depending on where the tumor or the cancer is,
either on the left or on the right, similar incisions can be made
that are usually three incisions of each about an inch long.
That will allow us to insert a camera and two instruments to resect the tumor
and then subsequently reimplant the radioactive seeds to the area where the tumor was.
For the esophageal surgery that you want to have access in the mediastinum,
which is in the middle of the chest but behind the heart, then the ports are usually placed
on the abdomen, on the belly, and then we have exposure to where the esophagus comes
in and connects with the stomach.
Then we can dissect along its side
without actually putting our hands inside the patient's abdomen
or behind the heart to get those areas.
So the robot will enable us to actually get to these small, tight areas without the exposure.
So again, it would be more comfort for the patient and less pain and faster recovery,
and frequently a lot less blood loss, and afterwards, the patient's return to function
and returning back to work and to their own environment more expeditious
after these procedures.
My first advice to the patient is that if, by some means they are considered to be high risk,
because of age or conditions that are considered comorbid lung disease or kidney disease,
then I advise them to get second opinions.
Second advice is, for example, for patients who have had a previous heart operation,
and now they need a second operation done.
Those patients should also, if they're considered to be at somewhat
of an increased risk, they should get a second opinion that they may not be at increased risk
if the appropriate preoperative care and preoperative planning is done.
And then the skills and the postoperative care do exist at another institution,
perhaps they should be doing that.