Robotics redefine cardiac surgery with precision, smaller incisions, new frontiers in AI and telesurgery

Editor's Note

Robotic-assisted cardiac surgery is reshaping the field, enabling safer, less invasive procedures once deemed too complex for minimal-access techniques, the American College of Surgeons October 1 reports. Advances in high-definition visualization, wristed instruments, and surgical control are allowing cardiothoracic teams to perform intricate repairs through incisions often smaller than an inch, reducing blood loss, pain, and recovery time.

Surgeons such as Dominic Emerson, MD, of Cedars-Sinai Medical Center and Husam Balkhy, MD, of the University of Chicago said robotic systems have ushered cardiac surgery into a new era. Dr Emerson reported repair rates above 99% for degenerative mitral valve disease using the robotic approach, with outcomes matching or exceeding traditional open-heart techniques. Dr Balkhy noted current systems provide up to twelvefold magnification and unmatched dexterity, qualities that have made procedures like mitral valve repair and coronary artery bypass grafting both feasible and effective through small incisions.

After early struggles in the late 1990s, newer fourth-generation robots now integrate tremor control and enhanced visualization, driving broader adoption. Studies cited in the article found safety benchmarks are achieved within the first 100 cases, though full expertise may take 250 to 500 procedures. Programs with structured mentorship can shorten this curve, and more residency programs are introducing robotics training to prepare future cardiac surgeons.

Recent research and clinical outcomes demonstrate comparable mortality and safety profiles between robotic and open procedures, with advantages in blood loss and recovery time. In one study coauthored by Dr Balkhy, 550 robotic mitral valve repairs achieved a 95.9% 30-day success rate and a 95% rate of minimal or no residual regurgitation.

Innovation continues to expand robotic cardiac capabilities. Drs Emerson and Balkhy pointed to artificial intelligence as the next frontier, following a Johns Hopkins experiment in which an AI-driven robot performed a gallbladder removal on a pig with minimal human input. Both surgeons said AI could soon assist in data analysis, imaging integration, and select automated tasks, though full autonomy remains a distant goal.

The technology has already reached milestones in transplantation and telesurgery. Cedars-Sinai performed the first robotic lung transplant in 2021, and US teams have since completed the first robotic double lung and heart transplants. Earlier this year, the world’s first intercontinental robotic cardiac telesurgery linked surgeons in France and India, demonstrating global potential for remote intervention.