Robotic Heart Surgery

Robotic heart surgery

da Vinci Xi

ADVANCED TOOLS & OUTCOMES

Robotic heart surgery offers superior 3D vision and greater instrument control. This makes surgery easier to perform and translates to greater patient safety.
The First Robotic Heart Surgery program in India!

You would be surprised to know this! There was no Robotic Heart Surgery done in India. The team at Apollo Hospital, Bangalore led by Dr Sathyaki Nambala was the first in the country to start robotic heart surgery in India. Backed by more than a decade of experience in minimally invasive surgery, robotic cardiac surgery was simply the next logical step. We have been known for our exceptional outcomes and safety record, we now add this additional expertise to make it even more better for our patients.

Greater precision, superior vision and excellent instrument control is what a robot offers. For the surgeon, its ease of doing a heart operation and for the patient, it translates to greater safety and better outcomes.

01

Mitral Valve Surgery 

Mitral Valve repair or replacement performed with safe outcomes. Multi valve procedures are also performed. 

02

Lung Surgery

All types of lung surgery, lobectomies and tumor resections performed. Ideal for thymectomy and mediastinal masses.
03

other heart surgeries

Closure of Atrial Septal defects, removal of cardiac tumors like myxoma’s and several other procedures.

Click in Image to watch Video

New tools new technique

A robotic heart surgery is performed by a team led by heart surgeons. Robotic instruments are just 8mm in diameter and they therefore cause the least amount of chest trauma. This make it the least painful and least traumatic form of minimally invasive surgery.

One oF A Kind

The Robotic Heart Surgery program at Apollo Hospital, Bangalore is one of a kind. It’s the only certified robotic heart surgery program in the country. Backed by more than 15 years of experience in minimally invasive heart surgery and led by Dr Sathyaki Nambala you can be assured of safety and excellent outcomes.

Robotic Mitral Valve Replacement with Tricuspid Valve Repair

most advanced & Complete

Our experience in robotics and minimally invasive surgery makes us the most advanced and complete cardiac surgery unit in the country. A team that’s well versed in handling challenges for more than a decade makes heart surgery extremely safe for patients.  We take pride in having hundreds of surgeons watch and learn from us and having represented the country in leading international forums. Our techniques have been demonstrated live in practically every part of the world. 

Call us OR Come on In!

We have a dedicated team that answers all your questions. Please don’t hesitate, give us call now. This could be the best decision you took in your life!

Minimally Invasive Aortic Valve Replacement

Minimally Invasive Aortic Valve Replacement (MICS AVR)

Advanced technique in Aortic Valve Replacement. Better outcome, faster recovery.

What is Minimally Invasive Aortic Valve Replacement?

Minimally invasive Aortic Valve Replacement or MICS AVR often referred to as mini AVR or key hole aortic valve replacement is the technique of aortic valve replacement through a small non bone cutting incision from the right side of the chest. It was first performed in 1996. The first few MICS aortic valve replacements were performed by groups at the Harvard Medical School’s teaching Hospital, Brigham and Women’s Hospital in Boston and the Cleveland Clinic. MICS AVR has been performed for close to two decades and has an excellent track record of safety.  When performed by trained surgeons who regularly perform minimally invasive procedures the outcome is definitely superior to the conventional technique. You can read more about aortic valve disease here.

Minimally Invasive Aortic Valve Replacement (MICS AVR)

Right Anterior Thoracotomy (RAT) Approach 

In this superior technique of minimal invasive aortic valve replacement the aortic valve is approached between the ribs on the right side. No bones are cut. Exposure is excellent and the technique of replacement is similar to the open operation.
The advantages of this approach are
1. No bones are cut.
2. Significant reduction in pain.
3. It allows for much faster healing. The cut is a mere 4cms.
4. Skin infection is  near zero and as no bone is cut the dreaded bone infection (Osteomyelitis)  is eliminated.
5. Not cutting the bone also decreases blood loss during the operation and this in turn translates into significantly reduced need for blood transfusion and the related complications of kidney failure and lung injury. 

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Reduction in Wound Infection

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Reduced Blood Transfusion

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Reduction in Pain

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Reduced Use of Narcotic Analgesia

There are two techniques by which MICS Aortic Valve Replacement can be performed. The Right anterior thoracotomy approach (RAT) does not require any bone to be cut. The Upper hemisternotomy technique requires the upper part of the sternum or breastbone to be cut.

As a technique the ‘RAT approach’ is superior but requires a skilled and experienced surgeon to perform the operation.

The Upper Hemisternotomy Approach

In this approach the upper part of the breast bone or sternum is cut. Only the upper 1/3rd of the sternum is cut leaving the lower one third intact. The skin cut is a mere 2 inches. This is a useful approach in those where a parasternal technique is considered difficult. The approach is useful in special situations where the entire aorta or the aortic root requires replacement (Bental procedure). Such an operation may be required when the aorta is enlarged above the aortic valve requiring replacement. Since the bone is cut this approach is considered inferior to the parasternal technique. It however has its role and is performed routinely the world over.

 

PARASTERNAL Aortic Valve Replacement
Right Anterior Thoracotomy Scar (RAT)

The recovery after the right anterior thoracotomapproach for aortic valve replacement is faster as no bones are cut. However not all patients are suitable for this approach. The decision on the right approach is made by the surgeon and depends on the anatomy.

The upper hemisternotomy technique involves cutting the upper 1/3rd of the sternum on one side. This cut in the skin is as small as the RAT approach and heals without complications. The pain is more than the parasternal approach though. Some restrictions to physical activity apply with this approach as the bone is partially cut. It should be noted that the recovery is much faster than open surgery.

Recovery after Minimally Invasive Aortic Valve Replacement

In general, recovery after a heart operation is influenced by the patients health prior to surgery. In those who have been active prior to their heart operation discharge from the hospital could be as early as 48 hours. When a parasternal approach has been used for valve replacement most patients can resume all normal activity within a week after discharge from hospital. Below are answers to a list of questions that patients frequently ask following their heart surgery. Please note that this is only a general guide and any special instructions given to you in particular, at the time of discharge, must be followed.
How soon can I resume brisk activity after my valve replacement?

Following a minimally invasive aortic valve replacement brisk activity can be resumed within a week. With the RAT approach (no bones cut) it can be resumed faster than with the upper hemisternotomy technique. Some patients are back to swimming within ten days after surgery. Brisk walking or normal daily activity is unrestricted after a week following replacement. Again it’s important to understand that the patients condition prior to the surgery will impact on their recovery after surgery. Onset of significant symptoms such as syncope or loss of weight in general mean that the disease is advanced or neglected and such patients may require longer to recover. Your surgeon should be able to tell you by his experience, on how long it would take for you recover in most instances.

Are there any additional risks attached to minimally invasive valve replacement?
No there are no additional risks to a minimally invasive procedure if performed by a formally trained surgeon. Its important to ask your surgeon where he trained in these techniques. While most surgeons may not like being asked these questions its important to know if your surgeon actually went through a formal training program in minimally invasive techniques. While most procedures can be done after attending a brief course, special situations will require formal training to save a life on the operating table. Unfortunately its not alway possible to predict when such situations arise. Its always best to consult an experienced minimally invasive surgeon with formal training for good outcomes. Minimally invasive aortic valve replacement is a well established technique and several scientific papers have already been published with equal or superior outcomes when compared to the open technique. These techniques definitely require more skill than conventional surgery and are probably unsafe to be practiced by untrained surgeons.
What is the length of hospitalisation after minimally invasive AVR?
The duration of hospitalisation does not usually exceed 3 days including the day of surgery in otherwise fit patients. Its important for patients to understand that their recovery is dependent on how fit they are prior to admission. Patients presenting with complications take longer to recover compared to patients who are active and without complications. Older patients may require a day or two longer.
Mrs VG underwent a minimally invasive aortic valve replacement for critical aortic stenosis about a year ago. This year she completed the 10km run in Hyderabad. This is a tribute to her spirit to overcome odds, the tenacity of the human mind and advantages of non bone cutting minimally invasive technique.

Endoscopic Radial Artery Harvesting

Endoscopic Radial Artery Harvesting: Standard of Care
ASHWINI M
EVH is an establised technique the world over.

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Patients recieving EVH in USA

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Pateints receiving EVH in Apollo, Bangalore

Endoscopic Radial Artery Harvesting

Coronary artery bypass graft surgery, or CABG is an established and life saving procedure. Its performed to bypass a blocked vessel in the heart and thus restores healthy blood flow to the heart. CABG or coronary artery bypass can be performed traditionally by cutting open the chest or minimally invasively termed MICS CABG or Keyhole bypass surgery or MICAS. Irrespective of how it’s performed the basic requirements remain the same.

This involves two primary steps

1. Healthy blood vessels are removed or harvested from the chest, leg, or arm. 

2. These are then used to bypass the blocked vessels.

The usual sites where the blood vessel is removed are

  • Internal mammary artery in the Chest
  • Long or Short Saphenous vein in the leg 
  • Radial Artery in the Forearm

The ‘bypass’ basically creates an alternative pathway for the blood to flow from the aorta to the Heart.

Open Vein Harvesting
“Endoscopic Vein Harvesting eliminates the long incisions, the associated risk of infection and pain. It allow’s patients to walk earlier without the discomfort of a long cut in the leg.”
Dr Sathyaki Nambala
ENDOSCOPIC VEIN HARVESTING — In Endoscopic Vein Harvesting  or EVH in short, the surgeon is able to remove the long saphenous vein or radial artery from a very small incision (approximately 2 cms). A specialized instrument called the endoscope (Hemopro 2 Vasoview) is used to isolate and remove the vessel under high definition videoscopic guidance. This is a very safe and reliable technique, provided the latest equipment is used by a skilled professional. The quality of the vein harvested is as good as that removed by the open technique.

ENDOSCOPIC RADIAL ARTERY HARVESTING — The radial artery, either from the left or right forearm is harvested using the endoscopic technique in suitable patients. It is therefore termed endoscopic radial artery harvesting. Unlike the open technique, which leaves behind a long ugly scar on the forearm, the endoscopic technique requires two small cuts that heal well with good cosmetic scars. The quality of the vessel harvested is comparable to the open technique. It’s important to understand that the radial artery may not be suitable to be used in all patients. Young patients are particularly likely to benefit from the radial artery being used as a conduit for bypass.

“The radial artery can be removed or harvested from the forearm either using the traditional open technique or the more advanced Endoscopic technique (EVH).”
The vessels that are removed are used to bypass blocked vessels of the heart. They provide an alternative route of blood flow to the heart muscle.
Bypass grafts

How do we know which of these is the better technique?

Open Vein Harvesting (Traditional Technique)

In this method the surgeon makes a long incision on your leg extending from the groin to the ankle for saphenous vein harvesting or arm  (extending from the wrist to the elbow for Radial Artery harvesting). This method has been in practice since the beginning of heart surgery. While being a safe and established technique it is primitive, crude and morbid.

  • This technique is also used as a back up when EVH fails in patients with very fatty legs or when the vein is diseased.

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MICS CABG (Multivessel) Part II

The Multi Vessel MICS CABG

MICS CABG is Safe and effective,
in upto 5 keyhole bypasses.

Yes, it’s the truth! We frequently meet patients who have been told “it’s impossible”. Here’s the evidence. Do we need to say more?

CT angiogram showing 5 functioning bypass grafts

Post MICS CABG, CT coronary angiogram showing all 5 bypass grafts functioning normally. 

Vessels grafted: LIMA to LAD, Radial Artery to Ramus Intermedius and OM, Vein grafts to PDA and PLV

Reliable Technique
Our technique is reliable and has been pioneered by us over half a decade. It’s what we do everyday.
Large experience
The worls’s largest experience in multivessel MICS CABG. We are truly proud of our achievements.
Evidence based
Several hundred patients have now undergone mulitple MICS bypasses. We have evidence to prove, it works!
CT angio Evidence
Still having doubts? Ask for a CT angiogram to prove the number of grafts you recieved. We are transparent.

Meet Mr NK…

Mr NK is 43 years old. He is married, has a brilliant career, eats healthy and exercises everyday. In short he is fit with no problems. He was diagnosed with diabetes in his 20’s but has well controlled his blood sugars.

During a routine health check recently his ECG did not look normal. He was advised an angiogram and to his surprise the angiogram showed four blocks in the blood vessels supplying his heart. He was advised a CABG also called coronary artery bypass. While this seemed simple enough, it wasn’t

Several questions ran through his mind. Who, Where, What options and What technique?

 

The NK’s took more than a month to look at all the options available. They were open to ideas and suggestions by family and friends especially in the doctor community. Considering his age, NK was not very happy about an open CABG. A new recommendation that emerged during the search for less invasive option to open CABG was the MICS CABG procedure performed by us in Bangalore.

 A family friend who had also undergone the same MICS CABG procedure vouched for it. When other surgeons and doctors were asked about the MICS CABG they were told that he required 5 grafts and it was impossible to do it by the MICS technique.

They finally decided to find out for themselves, flew in to Bangalore and met me at Apollo Hospital. They understood how safe the procedure was after meeting with other patients inside the hospital who had already undergone the procedure. Now, they were all set to undergo a MICS CABG.  

A week later he underwent a successful MICS CABG procedure with grafts to all the five blocked vessels. He did incredibly well and went home 4 days later. That’s not all. We did a CT angiogram for him which showed all 5 bypass grafts functioning well.

Please see the picture of the CT Angiogram at the top for details. 

 

MICS CABG
Safe Reliable Outcomes.
Yes, the way we do a coronary bypass (CABG) has changed. Say ‘Good Bye’ to pain and prolonged recovery. And yes, practically everyone who needs a CABG is a candidate.
It’s painless

Significantly reduced pain compared to regular surgery.

It’s bloodless

Our blood usage has reduced by 70%. It’s as close to bloodless as possible.

Active faster.

Less disruptive to body tissue, non bone cutting allowing faster movement.

Zero infection

Infections are no longer a problem as they simply don’t happen. Even in diabetics!

Difficult for us to believe. Left the hospital on day 4, all 5 vessels bypassed and a CT angiogram that proved that all the bypass grafts were functioning well.

imageMr NK.

MICS CABG (Multivessel) Part I

MICS CABG (Multivessel) Part I

How many bypasses can be done by the MICS CABG technique?

This is a question that’s frequently asked by patients. Why does this question arise so frequently?

The vast majority of patients who are referred for bypass surgery (CABG) require two or more bypass grafts. The medical community is still not fully aware of the technique of MICS CABG and its wrongly believed that only a single graft can be done by MICS CABG. This is because most surgeons are still learning the technique and are capable of performing a single bypass. When these surgeons or physicians are consulted they incorrectly advise patients against undergoing an MICS CABG. This article was particularly written to educate and to simply to dispel this myth.

Are these patients given wrong information? In a way yes although it may be more from ignorance rather than on purpose. Many senior physicians are actually unaware and spend little time in updating themselves about current techniques. Less often we find that although the physicians knew, they actually discouraged patients from undergoing a less invasive procedure that was actually beneficial. The reasons for this are manifold. First incomplete knowledge breeds fear. Older physicians may be in touch with older surgeons who are unable to adapt to evolving techniques and therefore may condemn them from the fear of loosing clientele. Some may find it uncomfortable to call a younger colleague to enquire about a technique they are unaware of. Irrespective of the cause, it’s the patient who ends up suffering.

In part II of this article I will highlight our experience with MICS multi vessel bypass with actual patient details and scientific evidence towards the same.

Please leave a comment. If you or a member of your family has undergone a multi vessel MICS CABG, do write your story.

Part II of this post will carry a true patient experience. Its a must read!

Multi vessel MICS CABG is possible and performed on a daily basis

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Patients receiving 2 or more bypass grafts by MICS

Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

Coronary artery bypass graft surgery, or CABG is an established and life saving procedure often performed to bypass a blocked vessel in the heart and thus restores healthy blood flow to the heart. This involves two primary steps

  1. Healthy blood vessels are removed or harvested from the chest, leg, or arm to be used in creating the vessel to be used as bypass or bypasses.
  2. The usual sites where the blood vessel is removed are
  • Internal mammary artery in the Chest
  • Long or Short Saphenous vein in the leg
  • Radial Artery in the Forearm

The bypass basically creates an alternative pathway for the blood to flow from the aorta to the Heart.

The vessels can be removed or harvested from the leg and forearm either using the Traditional Open Harvesting technique or the more advanced Endoscopic harvest (EVH) technique.

%

Patients recieving EVH in USA

%

Pateints receiving EVH in Apollo, Bangalore

Bypass grafts

How do we know which of these is the better technique?

Endoscopic Vein Harvesting (EVH)

With EVH, the surgeon is able to remove the long saphenous vein or the radial artery from a very small incision (Approximately 2 cms). He uses a specialized instrument called the endoscope to isolate and remove the vessel under high definition videoscopic guidance. This has been a very safe and reliable technique.

EVH is particularly recommended in those with diabetes, peripheral vascular disease, smokers, those with skin infection and in the obese. In general practically all patients in all age groups benefit from EVH. EVH does add a small additional cost to the operation on account of the disposable device used.

Open Vein Harvesting (Traditional Technique)

In this method the surgeon makes a long incision on your leg extending from the groin to the ankle for saphenous vein harvesting or arm  (extending from the wrist to the elbow for Radial Artery harvesting). This method has been in practice since the beginning of heart surgery. While being a safe and established technique it is primitive, crude and morbid.

  • This technique is also used as a back up when EVH fails in patients with very fatty legs or when the vein is diseased.

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