The use of robotic technology has rapidly expanded in cardiac surgery, thoracic surgery and interventional cardiology over the last several years. As one of the state’s busiest robotic cardiothoracic surgery programs, Baylor Scott & White The Heart Hospital – Plano continues to invest in this growing field in order to provide even more minimally invasive options for patients.
Because of the hospital’s experience and dedication in the use of robotic surgery technology, Baylor Scott & White Heart – Plano is often one of the first hospitals in the region to perform new robot-assisted procedures or to offer enrollment for clinical trials seeking to advance this technology.
Robotics in Thoracic Surgery
In thoracic surgery, the majority of procedures at the hospital are now performed using robotics. Surgeons on the medical staff at Baylor Scott & White Heart – Plano are using robotic surgery technology in procedures such as biopsy of lung nodules, lobectomy for lung cancer, mediastinoscopy and thymectomy.
“First and foremost, it’s the least invasive operative approach, which generally results in reduced pain, reduced length of stay in the hospital and faster recovery,” said Kimble Jett, medical director of the thoracic surgery program at Baylor Scott & White Heart – Plano. “It also allows the surgeon better vision and better precision, which usually translates to a better overall operation for the patient.”
The hospital’s focus on robot-assisted lobectomy has resulted in improved outcomes for these patients. The use of robotic surgery technology allows physicians to do an anatomic lung resection and a complete lymph node resection with four incisions the size of a fingernail and remove the lung through a 1 ½ inch incision below the ribs. Half of lobectomy patients now go home the first day.
To further advance the use of robotic surgery technology in lobectomy, the hospital is currently involved in a retrospective study to look at the outcomes following the procedure. While the majority of lobectomies at Baylor Scott & White Heart – Plano are performed using a minimally invasive approach, across the county about 70 percent of operations are still performed using an open approach.
“Robotic lung surgery is still early in development and most studies have been with programs early in their learning curve,” Dr. Jett said. “This study is for centers like The Heart Hospital that are past the learning curve to compare the outcomes of robotic surgery versus video-assisted thoracic surgery (VATS) versus open surgery. The hope is to demonstrate that the minimally invasive approach with robotic surgery is superior.”
Robotics in Interventional Cardiology
In the area of cardiac catheterization for coronary artery disease, robot-assisted procedures are relatively new when compared to cardiac and thoracic surgery. The first robot-assisted percutaneous coronary intervention (PCI) in Dallas-Fort Worth was performed at Baylor Scott & White Heart – Plano in January 2017.
The hospital offers the CorPath® GRX System, which is the only robot-assisted PCI system approved by the FDA. The system is designed to improve precision in the movement of guide wires and catheters. It also provides a reduction in radiation exposure for the physician.
“At this point, the robot is a new technology,” said Srini Potluri, medical director of the cardiac catheterization laboratory at Baylor Scott & White Heart – Plano. “The current generation increases the precision and accuracy of sizing the stent and has shown to be safe.”
Cardiologists on the medical staff are already investigating other uses of the robot for peripheral artery disease, carotid stenting and other percutaneous interventions. The hospital also recently enrolled the first patient in the country in the Precision GRX research registry, which is collecting data on the use and effectiveness of robot-assisted PCI.
According to Dr. Potluri, the cardiac catheterization laboratory at Baylor Scott & White Heart – Plano will be closely involved in the future advancement of robotic PCI technology.
“Future developments in robotic PCI technology will have a lot of automation built in and reduce human errors – like the lane assist and automatic braking in cars,” Dr. Potluri said. “In reality, we are behind the current technological advancements that we see in cars and our phones.”
Robotics in Cardiac Surgery
Baylor Scott & White Heart – Plano has been using robotic technology in cardiac surgery since 2011. Some of the most common robotic surgeries are mitral valve repair, tricuspid valve repair and concomitant repairs. Using robot-assisted surgery, surgeons on the medical staff at the hospital also are able to replace the mitral valve in patients who have excessive calcium buildup that previously would have prevented them from having an operation.
Because robotic surgery is the most minimally invasive surgical approach to the heart, the advantage is usually less morbidity resulting in a quicker recovery.
“It is important that we aim to reduce recovery times of serious surgical procedures,” said Robert L. Smith, II, MD, medical director of cardiac robotics at Baylor Scott & White Heart – Plano. “With the robot, surgeons are able to follow the same surgical principles that lead to quality outcomes through an open surgical approach, except they usually are with a fraction of the recovery time.”
Baylor Scott & White Heart – Plano is also involved in research to continue to expand the use of robotics in cardiac surgery. Through the SITRAL study, surgeons are investigating the use of a balloon expandable valve in the mitral valve position with robotic assistance for patients with excessive calcium in the valve.
Additionally, the hospital is involved in a national hybrid revascularization trial, which is treating patients with complex coronary artery disease with a combination of a robotic surgical bypass and stents.
