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If Minimally Invasive Cardiac Surgery is so Advantageous, Why Isn’t it More Common?

When patients come into our OP, we are often asked two questions.
How does Minimally Invasive or Robotic Cardiac Surgery compare to a normal sternotomy? Why are they not more commonly practiced?

A sternotomy involves splitting the central chest bone (sternum) to access the heart whereas Minimally Invasive Cardiac Surgery (MICS) makes use of small cuts in the chest (intercostal space), to pass a (thoracoscopic) camera or in robotic surgery, robotic arms through. Robotic (also known as Robotic Assist) Cardiac Surgery is the newest and most advanced form of MICS.


The advantage of Robotic over conventional MICS is that it is performed with even higher precision. All of the advantages of MICS are amplified even further through Robotic Cardiac Surgery. This is because the robotic arms do not tremor, have 360° movement and there are four robotic arms as opposed to the two hands usually available to a surgeon. There is also a magnification 10x higher than what the naked eye provides.


The advantages of MICS over conventional sternotomy are:

- less trauma to the body (no bones split, small cuts instead of a large scar)

- Less pain

- Minimal blood loss

- Hospital stay of only 2-4 days with full recovery to normal work in 2-4 weeks (compared to 2
weeks hospital stay and 3-6 months for full recovery with Sternotomies)


These advantages are amplified in Robotic Cardiac Surgery:

- almost no trauma to the body (robotic arms do not require the spreading of ribs and tissues to
access chest cavity)

- Almost no pain

- Negligible blood loss

- Hospital stay of 48 hours with full recovery in 2 weeks


Both forms of surgery are not commonly practiced simply due to a lack of expertise. In India, only around 3 centers routinely perform MICS, with Robotic Cardiac Surgery only being practiced by very few surgeons across the globe. I have gained 20 years of training abroad including 1 year in Belgium especially training in robotic surgery in order to be able to practice both forms of surgery routinely. My team and I have been performing Robotic Cardiac Surgery since 2012 and have completed over 100 successful procedures. It is still an evolving technique but even in its early stages the results with MICS or Robotic Cardiac Surgery are consistently better than what is achieved with a traditional sternotomy.


-Edited by Anjali Parmar (Medical Student, University College London)