State's first robotic-assisted multiple-artery cardiac bypass


UC Davis Medical Center surgeons have performed the state’s first robotic-assisted cardiac bypass procedure involving multiple arteries. The highly complex but minimally invasive operation offers patients quicker recovery times and less blood loss than conventional open-heart bypass.

diagram of incisions in bypass procedures
Robotic-assisted procedures to treat cardiovascular disease can provide all the benefits of conventional open-heart surgery with the recovery advantages of a minimally invasive technique.

Cardiothoracic surgery is one of four specialties in which UC Davis Medical Center offers robotic-assisted surgery. UC Davis specialists have been using robotic-assisted equipment for more than five years, mainly in cases involving gastrointestinal conditions, gynecologic cancers and urologic conditions such as prostate cancer.

In contrast to conventional heart surgery, which requires a patient's chest to be opened at the sternum, a robotic-assisted arterial bypass only requires tiny incisions between the ribcage. Surgeons use a specially designed computer console to guide tiny surgical instruments on thin robotic arms, allowing them to make highly precise movements while working within a very small area around the heart.

"Our patient received all of the benefits of conventional open-heart surgery with all the recovery benefits of a minimally invasive procedure," said W. Douglas Boyd, a professor of cardiothoracic surgery who collaborated on the case with surgeons Charles Whitcomb and Jerry W. Pratt. "Research shows that this type of surgery improves long-term survival without any of the downsides that come from having to crack the sternum and open up the chest.

“Patients can be back on their feet within weeks, rather than months, because muscle heals more quickly than bone."

Unique combination of bypass and stenting

surgeon using daVinci robot
Surgeons use a specially designed computer console to guide tiny surgical instruments.

The successful case, which involved a 49-year-old patient suffering from multi-vessel coronary artery disease, was also unique because it combined a robotic-assisted bypass with an arterial stent that opened the one secondary clogged vessel that could not be reached during surgery because of its position behind the heart (a stent is a tiny mesh tube that fortifies the blood vessel wall, helping to keep it open and allow blood to flow freely).

This highly effective combination of procedures is available at only a handful of hospitals in the nation.

"These hybrid procedures provide the best of what traditional cardiac surgery and interventional cardiovascular procedures offer patients," said Whitcomb, an associate professor of cardiovascular medicine. "A patient can have the durability of bypass surgery with the ease and safety of a coronary stent."

Boyd, who completed the world's first closed-chest, beating-heart coronary artery bypass using a robotic system more than a decade ago, noted that UC Davis' first case did not require the use of a heart-lung machine, as it normally is during conventional bypass surgery.

"Because we didn't have to stop the heart to operate, the patient didn't need a blood transfusion," said Boyd. "One of the risks of a conventional bypass surgery is the need for a heart-lung machine, which can add to a patient's complications from increased swelling and blood loss. The robotic-assisted procedure offers patients the least traumatic heart surgery and the best long-term outcomes."

Faster recovery

surgeon using daVinci robot
The lead surgeon sees the magnified operative field through a 3-D video monitor.

Robotic-assisted procedures represent the latest development in minimally invasive surgical technology. During an operative procedure, the surgeon sits at a control console near the patient while another physician is at the patient's bedside. The lead surgeon works at the console, seeing the magnified operative field through a 3-D video monitor and manually controlling several robotic arms using hand-held devices that replicate the surgeon's every hand movement.

The procedure uses several very small, keyhole-sized incisions through which a tiny camera and surgical instruments are placed. The small incisions help reduce the length of recovery time and speed up a patient's return to normal activities. There is generally less blood loss during robotic-assisted surgery, enabling patients to more quickly regain strength and stamina.

"In terms of bypass surgery, the robotic-assisted approach is about as sophisticated as it gets,” said Pratt, an associate clinical professor.

The robotic-assisted machine cannot be used for every coronary artery disease patient. Individuals are screened on a case-by-case basis and must meet specific criteria, such as having appropriate target vessels, to be considered appropriate candidates for the procedure.

For more information on robotic-assisted surgery at UC Davis, click here.