A young cardiovascular surgeon at Hamilton Health Sciences is pioneering a new method of repairing heart valves that is as effective as conventional techniques but much less grueling for patients. Dr. Victor Chu is one of the first surgeons in Canada to use a robot to assist him in minimally-invasive mitral valve repair.
The mitral valve is one of four valves in the heart. It flaps open and closed to permit blood to flow from the left atrium into the left ventricle without allowing any backward flow into the atrium. Sometimes, the mitral valve stops functioning correctly and a surgical repair is necessary.
The conventional approach is to make a 25- to 30-cm incision through the breastbone (or sternum) to gain access to the heart. With the minimally invasive technique that Chu uses, a 5- to 6-cm incision is made on the patient’s right chest. Another smaller incision (less than 1 cm) is made, also on the right chest, to allow insertion of a scope. Chu uses special instruments to operate on the heart through the larger hole. The scope gives him a clear, magnified image of what he’s doing. That image is projected on a television screen in the operating room so the whole surgical team can see the procedure.
The robot assists by handling the scope. Through voice-activated commands, Chu is able to tell the robot to move the scope and the robot responds by making precise adjustments. Unlike a human assistant, the robot never tires and always holds the scope steady – a key advantage considering the delicate, microscopic nature of the surgery.
While Chu likes having the help of a robot, the patients like the fact that they recover more quickly when the minimally invasive technique is used. Since the incision is shorter and there is less retraction and pulling on the bones and tissues in the chest, there is less pain after the procedure. Another bonus is that the scarring is smaller and less prominent.
“Patients recover more quickly,” said Chu. “Instead of spending five to seven days in hospital recovering from conventional surgery, these patients are discharged in three to four days. They are able to get back to their normal lives much faster.”
The anesthetist has an important role to play in this procedure. Dr. Ashraf Fayad, who has worked with Chu, performs echocardiography during the procedure. He uses an echocardiogram (ultrasound of the heart) to produce images of the valve and surrounding tissues and lines – images that help to confirm that the operation is proceeding correctly. Also, since one lung is deflated to allow access to the heart, Dr. Fayad is particularly careful to monitor the patient’s respiration during the operation.
For the nurses in the OR, this innovation is exciting and interesting.
“With the conventional technique, only the surgeons could see the operative field. But with this approach, it’s on the TV in the OR and we can all see,” said cardiac service resource nurse Sonya Hansen.
“This new technology keeps us on our toes and gives us a chance to help make an important advancement in cardiac care.”
A graduate of McGill University’s medical school, Chu joined the staff of Hamilton Health Sciences just last summer. Prior to coming to Hamilton, he spent a year in Greenville, North Carolina learning minimally invasive techniques at East Carolina University, the world’s leading centre for this type of mitral valve repair.
Although HHS does not own the robot Chu uses, it is on the hospital’s capital equipment shopping list. For now, the company that makes the robot, Computermotion, has loaned it to the hospital for a few initial procedures. As part of the development of a minimally invasive program at HHS, Hamilton Health Sciences Foundation has made an initial investment of $100,000 in instruments and video equipment.