Anyone seen research on this? More act needed with Robotic replacement?

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Duffey

Duffey

Me and Granbon
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My husband works in an SICU that gets a fair number of valve replacements. He mentioned that patients who have a robotic replacement require more anti-coagulation.
Anyone have an explanation for why this is?
 
I haven't heard of this, but my guess is that the stitching by the robot isn't as smooth or consistent as that by a real hands-on surgeon. This may leave more surfaces onto which clots can form, requiring more anticoagulation. (Funny, I hadn't heard of robotic surgery for valve replacement)
 
Are you talking temporary, post-op ACT? My surgeon told me that his Da Vinci patients typically spend twice the time on the heart/lung during surgery as his mini-thoracotomy patients. Could that have anything to do with it?
 
Yes, to clarify, he was talking about temporary, post-op ACT for Da Vinci patients. When they first started using the Da Vinci, there were more post-op complications due to the bleeding issue. There's a learning curve that the surgeons had to conquer.
 
Call me old-fashioned (which in many ways I am) but I want a surgeon who has graduated from med school and performed hundreds of successful surgeries, not a surgeon who was assembled by technicians. This may be a Luddite perspective on my part, but that's the way I feel.

REVISION: Okay this was probably a dumb comment on my part. I had just seen the machinery at a health fair and it kind of gave me the willies. But I am not well-informed on this. Duff Man makes (later on in this thread) the good point that this is an aid to the surgeons not a replacement surgeon.
 
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Curiouser and curiouser, since "more post-op complications due to the bleeding issue" would NOT be helped by taking more anti-coagulation! (ACT prevents clot formation, but it generally makes bleeding problems last LONGER.)

It's a sobering thought that our OHSurgeons are human, and have "learning curves" just like the rest of us. I often say that even the rocket-scientist types "didn't get 100% in school, and they're not getting 100% on the job, either, just like the rest of us".

I vaguely remember a stand-up comic saying something about going in for brain surgery and hearing his surgeon muttering "Gosh, I wish I'd paid more attention in Med School!"

All other things equal, that old saw "practice makes perfect" has some serious truth to it.
 
I wonder if, having less body trauma with robotic surgery, the patient's metabolism isn't in quite so much shock, and therefore metabolises the warfarin at a more "normal" rate than the usual post surgical patient. We all know we generally have to increase our dosage over the weeks after surgery as we heal and our activity levels/metabolism increases. If the robotic patients are up and about sooner, and more active than typical OHS/Sternotomy patients, maybe that contributes?
 
Duffey said:
My husband works in an SICU that gets a fair number of valve replacements. He mentioned that patients who have a robotic replacement require more anti-coagulation.
Anyone have an explanation for why this is?
Click to expand...

I wasn't on any more anti-coagulation than anyone else. My surgeon performed a mitral valve repair with the davinci.


Marcia58 said:
Are you talking temporary, post-op ACT? My surgeon told me that his Da Vinci patients typically spend twice the time on the heart/lung during surgery as his mini-thoracotomy patients. Could that have anything to do with it?
Click to expand...

This is a misconception. You are on the heart/lung machine just as long as the routine surgery. I see a lot of misinformation about robotic surgery here from time to time. My advice to anyone needing heart surgery: Do the research on it and find a surgeon that has a ton of experience with the davinci robot. I know Cleveland Clinic as well as St. Joseph's in Atlanta are proficient with it. For mitral valve repair/replacement it is the same exact surgery, but provides a greater chance of repair, minimal scarring, and short recovery time. Ok, i'm off my soapbox :)
 
Duffey said:
How can you be sure of that? I certainly don't know what medication dosage I was on while hospitalized post-op.
Click to expand...

I'm just going by what my surgeon told me and my family post op. They said it is the same exact surgery, so i don't see why robotic hands performing it would allocate more blood thinning meds. The robot actualy provides more precision and dexterity. It's been almost three years, so if i have the opportunity i will shoot them an email and ask to make sure.
 
My story is the same as Ryan since we had the same surgeon. The animosity towards robotic patients is pathetic.
 
I certainly don't have any animosity towards robotic patients.

I'm just trying to determine why, in my area of the country, patients who have had the Da Vinci assisted surgery are given more anticoagulants immediately post-op than those who have the conventional repair.

Perhaps it's a regional thing. I don't know; that's why I started the thread.
 
Nothing against your question Duffey, it's certainly legitimate. It's true however that there is some bias against those who have gone the robotic route.
 
Like Ryen O who had the same Dr. as I had mitral valve repair with the Davini I had few complications. My surgery was 5 years ago and I went daily for blood work after I got home and I had too much coumadin. They took me off on the 2nd day home. After my blood returned to normal. I took a bably aspirin and never had another problem. I still take one a day. I "knock on wood" still feel terrific!
 
Duffey said:
I'm not doubting your statement about some being biased, but I do think that any who hold a bias are indeed silly people.
Click to expand...

I agree and actually was surprised a couple days (weeks?) ago when I read people complaining there was a bias against people who had robotic surgery, I never noticed that, granted there are way too many divisions here, but I personally never have seen nasty threads between robotic or tradional surgery like there is for so many other threads about choices. IF anyone feels that way I'm sorry to hear it.

IMO Even that thread where someone complained about the bias, I read and reread the posts and didn't see what they were complaining about, yes there was some discussion about tried and true vs newer without a long track record, but that is true with any of the 'newer" things wether valves, surgeries or even meds, some people feel more comfortable staying with the choice that has a long track record and others rather have the newer things in hopes they turn out even better for them.

Granted when someone post a question about robotics, the threads are usually pretty slow without many replies, but that is mainly because not as many people have experience with Robotic (or even min invasive) so they don't have much to offer. I don't know if maybe people who chose to have robotic surgery are getting nasty PMs or something, but as for the forum I just don't see the bias..especially one that is so bad it was called pathetic.
 
Lynlw said:
I agree and actually was surprised a couple days (weeks?) ago when I read people complaining there was a bias against people who had robotic surgery, I never noticed that, granted there are way too many divisions here, but I personally never have seen nasty threads between robotic or tradional surgery like there is for so many other threads about choices. IF anyone feels that way I'm sorry to hear it.

IMO Even that thread where someone complained about the bias, I read and reread the posts and didn't see what they were complaining about, yes there was some discussion about tried and true vs newer without a long track record, but that is true with any of the 'newer" things wether valves, surgeries or even meds, some people feel more comfortable staying with the choice that has a long track record and others rather have the newer things in hopes they turn out even better for them.

Granted when someone post a question about robotics, the threads are usually pretty slow without many replies, but that is mainly because not as many people have experience with Robotic (or even min invasive) so they don't have much to offer. I don't know if maybe people who chose to have robotic surgery are getting nasty PMs or something, but as for the forum I just don't see the bias..especially one that is so bad it was called pathetic.
Click to expand...

I also haven't noticed a "bias" per se or any negative comments toward those who have had the robotic surgery. At least not directed toward myself. The only thing i've noticed mainly is a lot of misinformation out there that could potentially scare a future heart surgery patient from considering robotic surgery. Granted, i'm not super involved in the forum anymore so i'm not privy to everything that has been said on the subject.
 
Misinformation would be a good way to put it Ryan. I think it's important that people know that a surgeon will always steer them to what his capabilities are. They will also go that extra mile to tell the patient that their way is best. There seems to be alot of sheep out there.

As far as the surgeons being merely technicians as someone said, my surgeon spent a good bit of his career doing heart transplants. I think he can find his way around the heart and is familiar with the surrounding chest area.
 
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