Week 5

This week, I saw a robotic valve repair surgery with Dr. Guy, alongside with Melanie. I have been very eager to see robotic surgery, and was so excited to observe! The surgery was performed with a device called the da Vinci, and the procedure performed was a mitral valve repair. What sets robotic valve repair surgery apart from open-heart surgery is that it can be performed minimally-invasively. Only a few incision points are required on the right side of the rib, versus open heart surgery where the entire sternum is broken to perform the procedure. This helps to vastly improve healing time for patients requiring valve repair. I had a discussion with Dr. Tranbaugh about the da Vinci the day before I went to observe the surgery, where he recalled when the device was first implemented in the early 2000s. He stated that robotic surgery was attempted for CABG patients, but ultimately was not implemented because the delicate tissues utilized in CABG require more precise tactile sensory information than a robot is able to provide. However, valve repair surgery deals with thicker, sturdier tissues than CABG, and thus has seen much success with robotic surgery. 

The surgery began with a very long preparation period. Multiple incisions were made on the right side of the patient, and large, round, hollow cylindrical devices were attached to these incisions. Also, bypass was performed minimally invasively. It was difficult to see exactly how this was done in the surgery, but it looked like the deoxygenated blood-line was placed using the TEE into the right atrium and the oxygenated blood-line was placed using a catheter somewhere in the aorta. Once everything was set up, the da Vinci robot arm instrument was rolled to the patient and installed. At this stage, Dr. Guy took a seat in the da Vinci VR control system, placed his hands into the virtual robotic surgical- tool simulators, and placed his feet on foot pads. He used the robotic tools and camera to access the thoracic cavity, and discovered that the typical access points to the heart were fused together. This was likely due scarring from a previous operation.

Dr. Guy repaired the mitral valve of the patient by first adding artificial cords to the valve. I believe this ensures the leaflet is unable to open further than it is supposed to, helping to keep the valve in place. Next, he sutured a ring that was open on one end around the valve. Rings are used in valve repair because they help keep the musculature and leaflets of the valve in the same level in the heart, preventing shifting and subsequent leakage, according to Dr. Tranbaugh. A second da Vinci screen was set up in the OR, and Melanie and I were actually able to observe what Dr. Guy saw on his da Vinci screen in 3D during the procedure!  It is amazing that a robot and 3D technology is able to interface so successfully with the surgeon in the OR. I cannot imagine the years of development it must have taken the da Vinci company to make their products so seamless.

Because we are unable to obtain all the data we need to complete the diabetic patient MVD MABG study before I leave, the scope of my research project has changed. I am now be analyzing 30-day patient outcomes and stenting/CABG ratios before and after Dr. Tranbaugh brought multiple-artery grafting to NYPBMH.  I have also taken on a small valve replacement project with Dr. Worku. This project will investigate the use of an automatic suture knot-tying device called the Cor-Knot in comparison to manual knot-tying. I will be comparing the aortic-cross clamp and bypass time, and the total surgical cost difference for aortic and mitral valve replacement using each knot-tying method.  

This past week I have also had some fun adventures in the city and in Brooklyn. A few classmates and I did an escape room in Brooklyn last Saturday, and became so addicted we did another one on Monday! We also explored the Dumbo area and walked across the Brooklyn Bridge (see picture below). Additionally, this weekend I got to see The Book of Mormon play with Hania on Broadway, which was so much fun! I am definitely going to miss exploring the city and working with clinicians when our immersion term ends.