Mitral valve repair ---->OHS vs Davinci

[Adrienne]

In terms of quality repair, even though I had DaVinci, I sincerely believe that a sternotomy, mini-sternotomy or thoracotomy is superior to the robotic approach. My surgeon is well versed in robotics and known for isolated mitral repairs, but I think the old fashioned way is a little better.
That's just my opinion, not fact.

I cannot see why you would think that a normal thoracotomy would be superior to the Da Vinci robot. It seems to me that they both go through the right side. However, from what I've read, the surgeon can see what he is doing much much better with the robot. Besides that, for every millimeter that the scalpel moves, his hand has to move about a centimeter. Therefore, there is not the "tremble factor". Now, when it comes to comparing the Da Vinci robot to a sternotomy, I really do not know which is easier or best, but certainly the Da Vinci has to be better and easier than the normal thoracotomy.

Any experts out there can tell me if I am full of &%*$.

 

[Bear72]

I cannot see why you would think that a normal thoracotomy would be superior to the Da Vinci robot. It seems to me that they both go through the right side. However, from what I've read, the surgeon can see what he is doing much much better with the robot. Besides that, for every millimeter that the scalpel moves, his hand has to move about a centimeter. Therefore, there is not the "tremble factor". Now, when it comes to comparing the Da Vinci robot to a sternotomy, I really do not know which is easier or best, but certainly the Da Vinci has to be better and easier than the normal thoracotomy.

Any experts out there can tell me if I am full of &%*$.

The reason why I have that opinion is there's a "feel" factor (surgeon's hand) if you will, that the Da Vinci does not necessarily replicate when repairing the valve. In a situation where there is a flailing valve and the need for artificial chordae to be attached along with the annuloplasty ring, the tissue around the valve may not be strong enough to support and the artificial chordae will again rupture. Is there a big difference? Absolutely not. A slight difference being that the surgeon MAY be able to feel it a little different as opposed to the robot. This is just info I received from a few surgeons.

As I said, it's my opinion from the information received from cardiologists and cardiac surgeons. In no way am I saying this is absolute fact. Why would I have this opinion? Because this is the exact issue I'm dealing with now, as a post-op DaVinci patient. Although very rare, it happens. When it does....you find yourself asking very specific questions about the repair approach considering the fact you were the ideal candidate pre-op for robotic repair.

 

[Johnz]

Intracatheter repairs

Intracatheter repairs

"Every surgeon that I've spoke to in both Cleveland, Philadelphia and NY agree it will all be intracatheter down the road. "

At present, I believe the they are testing the use of a clip via catheter to partially repair the MV on elderly patients or those whose frailty for whatever reason face a great risk from OHS. The solution sounds elegant and will hopefully lead to many more advances in the future. However, it is hard to imagine that complex repairs or replacements are going to be performed via catheter for a long time. Over the next couple of decades, miminally invasive surgical techniques are going to be necessary and desirable for all the reasons already stated in this thread. The da Vinci isn't right for everyone (they won't use it if you also need a coronary bypass while they're in there or have other complications), but for a growing class of patients, it's awesome.

 

[Johnz]

With regard to the supposed tension between traditional surgeons and the da Vinci practitioners, I can only comment on my observation having interviewed one of each: my traditional consult was dismissive with regard to the usefulness of the robot to perform DIFFICULT repairs. He even went so far as to assure me that my Cleveland surgeon (who he knew personally) would not operate on my valve with the robot because my repair was too challenging. (Wrong.) He was at the conference where the Cleveland team presented its competitive results for da Vinci and he felt strongly that the only reason the paper looked competitive was because Cleveland was not using the robot for the tough cases. I put that question directly to my Cleveland surgeon and he was amused (and disagreed). What I could not deny is that heart surgery centers are big business and there's lots of salesmanship at work. It's our responsibility to be as educated as we can be, because they want our business. My traditional consult actually insisted there was no statistically significant difference in recovery time between his preferred open chest approach and the minimally invasive results. I was shocked to hear him make such a seemingly unsupportable claim. I felt he was being competitive, not necessarily honest. I imagine that at this point in his very successful career he was not about to go learn how to operate the robot and - in essence - start over. But that doesn't mean he doesn't perceive a competitive threat from this technology. I'm sure he would have performed a good repair on me, but I'm really glad I didn't have to have my chest cracked open to get the same result.

 

[Bear72]

"Every surgeon that I've spoke to in both Cleveland, Philadelphia and NY agree it will all be intracatheter down the road. "

At present, I believe the they are testing the use of a clip via catheter to partially repair the MV on elderly patients or those whose frailty for whatever reason face a great risk from OHS. The solution sounds elegant and will hopefully lead to many more advances in the future. However, it is hard to imagine that complex repairs or replacements are going to be performed via catheter for a long time. Over the next couple of decades, miminally invasive surgical techniques are going to be necessary and desirable for all the reasons already stated in this thread. The da Vinci isn't right for everyone (they won't use it if you also need a coronary bypass while they're in there or have other complications), but for a growing class of patients, it's awesome.

I'm not referring to the clip what so ever, that's actually old news when it comes to isolated mitral surgery. I do however agree that recovering from the DaVinci is twenty times easier that a sternotomy or thoracotomy.

 

[chaidell]

Thought this was an interesting thread I started a while back. I ended up going the OHS route, and have no regrets. My scar (5 inches) is much smaller than I thought it would be.


I have learned a lot about the different techniques, and found advantages for both.

OHS:
- easier and faster to organize a closet while opening it, instead of poking holes in the door to accomplish the same task.

Minimally invasive
- less pain, and faster recovery time.