Robotic Myectomy anyone?

[Marko]

Anyone familiar with any centers doing Septal Myectomy using DaVinci?

After years of using medication I am finally moving forward with surgery and my appointment at Emory with Dr Guyton is in two weeks (I live in Atlanta). I haven't met the surgeon, so I don't know if they would use their DaVinci for this, however, there appear to be some surgeons who will.

https://roboticheartsurgeon.com/hype...ardiomyopathy/

I have no problem jumping on a plane in order to avoid having my ribs spread...

Thanks
-Marko

[gfox42]

Re: Robotic Myectomy anyone?

Hi Marko,
As far as I understand, myectomy is not normally done with robots at present. That doesn't mean it might not be at some time in the future, but the leading surgeons say (and here I'm relying on my memory of what they've said aloud when asked this question, for example at HCMA annual meetings) that too much of the procedure relies on information based on the surgeon's feel.

This may well change over time as techniques and knowledge improve, but at present I think I'd stick with Dr. Guyton.

Gordon

[Jordan Z.]

Re: Robotic Myectomy anyone?

The use of robotics for surgery, and remote "telesurgery" as well has been substantially focused on minimally invasive procedures that rely on a laparoscopic incision to minimize the incision and associated recovery time. Unless and until an approach is developed where in a myectomy could be performed in such fashion, there isn't much potential benefit from the use of a robot, as an open procedure relies on the physical skills of the surgeon. If I were going to seek to understand where the cutting edge of the use of robotics is, I would certainly extend my search beyond cardiac surgery as the advances are being made in many varied subspecialties.

In a specific case with any procedure, if you are wondering, ask the surgeon how he intends to undertake the procedure. In many procedures, there are multiple approaches to accomplish the same task, and if your investigation of the particular procedure could entail alternative approaches....how better to understand than asking the person that is going to be performing the task.

Best of luck for a successful surgery.

[Marko]

Re: Robotic Myectomy anyone?

Yeah, as I reviewed the video again I saw that this myectomy was performed in the middle of a bovine mitral valve replacement, where access to the septum was achieved with a leaflet cut away.

Then a bovine valve was used for repair and from what I've read the bovine valves as not as durable as human valves and only last about 20 years... so in order to avoid having valve surgery in 20 years I would need to go the sternal surgery.

I'll still reach out and talk to Dr Guy's office to see if the robotic myectomy can be done without a valve replacement...but it might not be an option.

Thanks

[angusjcampbell]

Re: Robotic Myectomy anyone?

Anyone familiar with any centers doing Septal Myectomy using DaVinci?

I have no problem jumping on a plane in order to avoid having my ribs spread...

I'm sorry if this sounds terse or unapologetic but this is one of the most misguided statements I have read read on this forum In a long time (besides maybe some of my own). I would jump on any plane, train or automobile or even dogsled ( I almost did that, going to cleveland in January) in order to visit a surgeon whose team spreads ribs over 200 times a year for myectomies.

In January just now this year I had a bad winter cold that was many times more discomforting than my open heart surgery. Last month I suffered symptoms from an inflamed gallbladder and would have preferred to have my chest cracked twice over.

With my cracked chest at least I knew what to expect and knew how to control my comfort. I was back at limited work duties in 11 days, was driving a couple of weeks after that. I was full strength in 12 weeks and all during that time I could control my comfort with simple planning. You can't do that with a lot of other things in life.

Just go to someone good with myectomies and wait for some other joker to be the first with something experimental.

[JillC]

Re: Robotic Myectomy anyone?

I agree... Having your "chest cracked" sounds much worse than it is. The truth is, the sternum is cut but muscles are not....the greatest pain after surgical procedures comes from cutting through muscles that are needed for everyday activities....abdominal surgery is much more painful than a sternotomy. Not sayin a sternotomy is a walk in the park....For me the effects on the body and brain due to the cardiopulmonary bypass , were harder than the pain....and even if a robot did the surgery you still have to go on cardio-pulmonary bypass.
I agree with Angus....Experience is the most important credential for this surgery.....No one likes pain.....However, ask me about the pain of having it done twice because the first surgeon was inexperienced !!!

[Jordan Z.]

Re: Robotic Myectomy anyone?

Just to clarify...I was back at work full time eight days post procedure and back on a bike at the gym three days after that. The pain from the sternotomy incision isn't bad at all....the shoulder pain for the first two weeks was hellish for me at least.....but, its certainly survivable with the proper meds. The two prior posts are spot on as well.

[mbcube]

Re: Robotic Myectomy anyone?

I had ask my surgeon if they had any plans to eventually do the surgery in a minimal incision fashion and he said "NO! I need to see and feel how everything works - especially together." While the thought of open heart surgery sounds intimidating (and it is!), I've had far worse pain with knee surgeries. You'd be surprised how fast you do recover!

[DEChengst]

Re: Robotic Myectomy anyone?

Having a bit of a fever at the moment and reading this switched my brain to full blown, over-the-top, geek mode. I thought it would be nice to put the scalpel under computer control directed by real-time 3D imaging of the heart. Calculate the tissue to be removed with a CFD simulation of the heart. Sub-millimetre accurate per patient optimized result. Sorry for going on a feverish rant, but maybe in 15 or 20 years this will really be the way a myectomy is performed.

[LindaSo]

Re: Robotic Myectomy anyone?

OK, let me sing a Meghan Traynor song...instead of the base......"It's all about the feel, 'bout the feel, 'bout the feel." Medicine and surgery are both an art and a science. The art part is the "feel". At our annual meetings surgeons have indicated that they don't expect robotics to be used for this particular surgery in the near future.

[Frosty]

Re: Robotic Myectomy anyone?

Just go to someone good with myectomies and wait for some other joker to be the first with something experimental.

Good thing that "joker" came along when they proposed that first myectomy.

[Jordan Z.]

Re: Robotic Myectomy anyone?

Just go to someone good with myectomies and wait for some other joker to be the first with something experimental.

Good thing that "joker" came along when they proposed that first myectomy.

The "jokers" may be well down the path....just as an example, the list of robotic cardiac procedures currently being performed at John's Hopkins include:

• Mitral valve repair/replacement
• Tricuspid valve repair/replacement
• Atrial septal defect/PFO closure
• Maze procedures for both lone atrial fibrillation and as a concomitant procedure with mitral valve repair
• Left atrial mass and myxoma excisions
• Biventricular epicardial pacing lead placement
• Robotic coronary artery bypass in appropriate patients

If one considers what is involved in a mitral valve replacement, perhaps robotic myectomy isn't that far off in the future after all.

Perhaps one of the interesting points of speculation is whether an innovation like minimally invasive [which robotic is a subset of] is likely to come from CCF or Mayo where the programs are well established and the patient volume is at a very substantial level or might it come from somewhere else which has expertise in other cardiac procedures which are more susceptible to a minimally invasive approach such as some of the valve replacements and get extended.

I did locate one study with a decent sample size that looked at the use of minimally invasive in mitral valve repair, and there certainly has been an increase in the use of the procedure http://www.annalscts.com/article/view/2886/3802 Its difficult to read the crystal ball but we may look back in twenty years and say "they were doing what????"

[Frosty]

Re: Robotic Myectomy anyone?

Not sure if we talking the same thing or not, Jordan, but all I am trying to say is that there has to be someone willing to undergo all new and experimental procedures (myectomy included) so that they are refined and doctors more proficient performing them. If there was not that first patient willing to undergo a myectomy then none of you who have had one would be in the position you are today.

Yes, robotic myectomy may not be viable, but none of us will know that until and unless it is tried. Who knows, it may even become the next "gold standard".

[Jordan Z.]

Re: Robotic Myectomy anyone?

Not sure if we talking the same thing or not, Jordan, but all I am trying to say is that there has to be someone willing to undergo all new and experimental procedures (myectomy included) so that they are refined and doctors more proficient performing them. If there was not that first patient willing to undergo a myectomy then none of you who have had one would be in the position you are today.

Yes, robotic myectomy may not be viable, but none of us will know that until and unless it is tried. Who knows, it may even become the next "gold standard".

I think we are substantially in the same place....what I did was try to articulate my view of how we will get there....I see the incremental progress coming from surgeons doing procedures other than myectomies pushing the envelope in other areas until we get there....but probably inevitable.

[angusjcampbell]

Re: Robotic Myectomy anyone?

Just go to someone good with myectomies and wait for some other joker to be the first with something experimental.

Good thing that "joker" came along when they proposed that first myectomy.

Just me being selfish. I could have had my myectomy in nearby Jacksonville and help boost their numbers towards maybe being high volume someday. Make the First Coast Region a better place for mankind and advance medical care for my neighbors in the region.... But.... Naaaah.