Singapore Offers Heart Patients Minimally Invasive Robot Assisted Surgeries

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Many centers globally have given up their robotic programs because of time and cost considerations, but looking to the future, the doctors believe this will become the new standard of care for heart patients.

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Many centers globally have given up their robotic programs because of time and cost considerations, but looking to the future, we believe this will become the new standard of care for heart patients.

Singapore's National Heart Centre (NHC) is one of a few centers in Asia that performs complicated mitral valve repairs with the aid of advanced robotic systems such as da Vinci.

"Our robotic assisted minimally invasive cardiothoracic surgery (RAMICS) program offers patients an alternative to conventional open heart surgery, which is the traditional way of treating mitral valve disease," explains Dr Chua Yeow Leng, a Senior Consultant for Cardiothoracic Surgery at NHC.

The heart - the body's most hardworking muscle - is fast becoming a global problem. According to Dr Chua, heart disease is a very common affliction and can involve the muscles, valves or vessels.

"Today, we are looking for fast-track recovery from heart surgeries and that's where robotics present a distinct advantage," he says.

At present, da Vinci offers the most effective and least invasive treatment option available. Surgeons operate through tiny openings in the chest, eliminating the need for sternotomy - a large incision through the breastbone or sternum.

This form of surgery offers many benefits compared to open-chest procedures.

"Open heart surgeries usually require an opening of about 15cm. Comparatively, with robotics, we need a much smaller opening, about 4cm on the right side of the body. The ribcage is not disturbed at all," says Dr Chua, who has performed about a half dozen cases of robot-assisted valve repair so far. All his patients have since fully recovered.

NHC performs about 120 isolated valve surgeries a year, of which two thirds are mitral valve repairs, both traditional and minimally invasive. Its mortality rate was only 1.92 percent, well below the international STS benchmark of 6 percent for mitral valve surgeries.

Of the benefits of robotic cardiothoracic surgery, two items stand out.

"Recovery time is a big plus. Conventionally, a person who has to engage in physical labor can only return to work after three months. Now, with robotics, the same person can be fit for work within a month, and there will be much less pain and scarring," explains Dr Chua.

By keeping the breastbone intact, robotics also reduces the chance for post-surgical complications, such as infection of the chest wall.

The minimal invasive method of heart surgery can also be applied to other heart and thoracic conditions. NHC has performed robotic-assisted operations including coronary artery bypass grafting, closure of congenital heart defects and excision of chest tumors.

The procedure:
The surgeon sits in a console equipped with controls that direct robotic arms to perform the surgery. The four robotic arms are essentially an extension of the surgeon's own hands.

A tiny camera attached to a robotic arm gives the surgeon a very detailed, three-dimensional view of the operating space inside the chest.

"The robotic arms are very agile with seven degrees of motion which mimicks the full dexterity of the surgeon's hands and it eliminates hand tremors as well," says Dr Chua.

Expertise is important for robotic surgery, however, as there is a steep learning curve associated with minimally invasive procedures.

"Many centers globally have given up their robotic programs because of time and cost considerations, but looking to the future, we believe this will become the new standard of care for heart patients."

Since the robotic systems are partially funded by the Singapore government, costs here have been kept to a minimum.

"The additional cost items for robotic surgeries are disposables such as tubing and instruments. A minimally invasive procedure here will cost about S$35,000 (US$25,000)," says Dr Chua.

In the U.S., a comparable operation will cost about twice as much.

About National Heart Centre:
National Heart Centre (NHC) of Singapore is the national referral center for cardiovascular disease in Singapore. It provides comprehensive preventive, diagnostic, therapeutic and rehabilitative cardiac services to local and overseas patients.

NHC has more than 9,000 inpatient admissions annually. Its multi-disciplinary team of surgeons carries out approximately 80,000 outpatient consultations, 75,000 cardiac investigative procedures and over 1,700 operations each year. The Centre is also the first heart hospital outside USA and in Asia to be accredited by the Joint Commission International (JCI) in 2005. For more information, visit http://www.nhc.com.sg/.

About SingaporeMedicine:
Launched in 2003, SingaporeMedicine is a multi-agency government-industry partnership committed to strengthening Singapore's position as Asia's leading medical hub and international health care destination. Led by the Ministry of Health of Singapore, SingaporeMedicine is supported by three government agencies: the Economic Development Board, which develops industry capabilities, the International Enterprise Singapore, which fosters regionalism by Singapore-based health care players, and the Singapore Tourism Board, which markets Singapore as a healthcare destination to inbound international patients and develops associated people-oriented services. Visit http://www.singaporemedicine.com/ for more information.

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