Robot-assisted heart surgery reaches Czech Republic

Photo: Nemocnice Na Homolce

I have just arrived at Prague's Na Homolce hospital. Last week, its cardiologists performed the first ever robot-assisted heart surgery in the country and they have since successfully operated on six patients.

One of them is Jiri T. from the Bohemian town of Chodov. Just last Tuesday, he was lying on the operating table - undergoing a heart operation that he had been waiting for since 1996 - now, he's out of bed and more than satisfied with the result:

"I compare how I feel to the condition that the other patients in this ward are in. They have undergone the conventional form of surgery and are complaining of chest pain and breathing problems. I have not suffered any of that. I am completely healthy and have miraculously recovered. I honestly never expected this."

Prague's Na Homolce hospital is the only in the country to offer robot-assisted heart surgery, but the practice is similarly rare in the rest of the world. There are an estimated 700 surgical robots in hospitals around the globe but most of them are used for abdominal surgery. I stopped by Dr. Stepan Cerny, head physician at the department of cardiac surgery, to find out more about the hospital's new project and how the robot really operates:

"The robot was actually used for the first time back in 2005 and it was mainly used for abdominal surgery by abdominal surgeons, urologists, and gynaecologists. Since then, it has been used on a routine basis and I would guess that over 200 operations have already been performed. We, the cardiac surgeons, started using it only a week ago and we have performed six cases since then."

And why did you start only a week ago?

"We needed more time to prepare the programme because the heart is very difficult to approach with the robotic system. Heart surgery is a special field that in most patients requires the use of a so-called extra-corporal circulation or a cardio-pulmonary bypass, which is a machine that works instead of the patient's heart and lungs during the operation and you have to place the patients on the cardio-pulmonary bypass and then perform the operation. It is very difficult to do that without opening the patient's chest so you first have to find a way and you have to be confident and familiar with the placement of the patient on the cardio-pulmonary bypass via his or her groin.

"There is also a difference between heart surgery and abdominal surgery because in abdominal surgery you remove something most of the time - a tumour or an inflammation - but in heart surgery, you have to create something in the heart, construct grafts, put in artificial valves and so on."

Many of us probably find it difficult to imagine what this robot looks like...

"It's actually not a robot. The word robot suggests that it works on its own but this equipment is actually a tele-manipulation system. It consists of two parts. One part is a 'cart' that carries the arms of the system, of the robot, and at the end of the arms are very fine instruments that are placed inside the patient's chest and one of them holds a camera that is also inserted into the chest. The other part of the system is a surgeon's console that can be placed in the same room or even in a different hospital and the surgeon sits at this console and operates masters and all his movements are transferred to the arms and that moves the instruments and performs the operation."

Does this mean that you can also be in a different country and operate from there?

"Yes, that is possible and it has already been performed across the Atlantic Ocean where the patient was on one side and the surgeon on the other side."

And what are the other advantages of using the robot?

"Of course the main advantage is that the procedure is less invasive. You do not have a large scar and there are only two or three tiny holes in your chest wall. Minimal invasion means less pain, faster recovery, and you can go home earlier than after conventional surgery."

Is it more expensive or cheaper?

"The operation itself is more expensive but while recovery after the conventional surgery takes six to eight weeks we believe that recovery after the robotic surgery is faster and patients will be able to go back to work earlier so that should become less expensive in the long-run."

Is there a type of heart surgery that you cannot use the robot for?

"Yes. Of course we are currently in the initial stage so we started with very simple operations. Step by step we will move towards more and more difficult cases but there are some surgeries that cannot be performed with the current technology at the moment."

Other hospitals in the Czech Republic are already investing in surgical robots. So by the end of the year, the Na Homolce hospital will hopefully no longer be the only health institution to offer the country's numerous heart patients the least invasive treatment possible and a faster recovery. Cardiac surgeons expect the technology to develop to such an extent that heart operations impossible to perform with the human hand will soon be made possible with the steady and precise mechanical hand of the surgical robot.