CABG stands for Coronary Artery Bypass Grafting. It’s a surgical procedure used to improve blood flow to the heart by bypassing blocked or narrowed coronary arteries. During the surgery, a surgeon takes a healthy blood vessel from another part of the body and uses it to create a new pathway for blood to flow to the heart muscle, effectively bypassing the obstructed arteries. This can help relieve symptoms of heart disease, such as chest pain, and reduce the risk of heart attacks.
Traditionally CABG has been performed by a chest incision which divides the central bone of the chest called sternum.
The usual time to recover from a traditional bypass is close to 8 to 10 weeks as the bone healing itself take around 6 to 8 weeks.
Minimally invasive cardiac surgery (MICS) refers to a group of surgical techniques used to treat heart conditions with smaller incisions compared to traditional open-heart surgery. This approach typically involves the use of specialized instruments allowing surgeons to operate through small openings in the chest.
Advantages of minimally invasive cardiac surgery include:
– Reduced pain and scarring
– Smaller incisions generally lead to less tissue damage.
– Shorter recovery time: Patients often experience faster healing and a shorter hospital stay.
– Less blood loss: Minimally invasive techniques usually result in less bleeding.
MICS can be used for various procedures, such as valve repair or replacement, coronary artery bypass grafting, and atrial septal defect closure.
Robotic-assisted CABG (Coronary Artery Bypass Grafting) is a minimally invasive surgical technique that uses robotic systems to help surgeons perform heart bypass surgery.
In this procedure:
– Robotic Technology: The surgeon operates from a console, controlling robotic arms that hold specialized instruments. This allows for precise movements in tight spaces.
– Small Incisions: Instead of making a large incision in the chest, several smaller incisions are used, which can lead to less trauma to the body.
– Benefits: This technique typically results in less pain, reduced scarring, shorter recovery times, and lower risk of complications compared to traditional open-heart surgery.
Robotic-assisted CABG can be particularly beneficial for patients with certain heart conditions and is becoming an increasingly popular option in cardiac surgery.
The surgeon operates the robot and he is very much present just next to the patient.The robot does not and can not operate independently.
The robot is used presently in accessing and harvesting the INTERNAL MAMMARY ARTERIES (IMA) which are the best arterial grafts available in the body for the bypass of heart arteries. These arteries are resistant to developing additional or new blockages.
This is done by very small 1 cm incisions on the chest and there are no additional incisions on the hands or the legs of the patient.
IMA* (Internal Mammary Artery, see the image at the bottom of FAQs) usually supply the central bone i.e the sternum and some muscles around it. There are other sources of blood supply the sternum and hence IMA can be spared and used for the heart blood supply with no effect whatsoever on the blood supply of the sternum (if they are taken robotically or in a MICS way)
Heart is predominantly a left sided organ and most of the arteries of the heart can easily be reached from the left chest incision as in a MICS or robotic assisted CABG.
We have even performed upto 5 bypasses in a single patient with MICS or ROBOTIC CABG
MICS usually takes about 1 hour more than conventional cabg while ROBOTIC cabg may last 2 hrs more than conventional surgery.
Additional time is not a concern for most of the patients as usually very stable and low risk patients are advised these special techniques.
Our cardiac anaesthetists are equipped and well trained to handle such situations ans we have even performed such surgeries in patients above 80 years of age.
Usually elderly patients find it more easy to have a small incision surgery as they recover very quickly from the same. The recovery process being short and due to very minimal tissue damage as MICS is a bone sparing surgery , helps the elderly to recover very fast.
In MICS and ROBOTIC CABG , there is no damage to the central bone . This ensures ZERO risk of Deep sternal infection , one of the most dreaded complication in diabetic patients.
Moreover, as the healing period is shortened, most diabetics enjoy early recovery to active lifestyle which aids in control of diabetes and maintains good sugar levels.
Mics is a wonderful technique to avoid big surgery. We have been doing mics bypass since 2012 being one of the earliest surgeons in Mumbai and Maharashtra to do MICS.
With MICS surgery we have performed up to 5 grafts all beating heart and with use of various combinations of left radial artery , saphenius vein and in some cases even bilateral IMA arteries
The success to harvest BIMA is limited by the body structure and chest and bone characteristic of a patient and in patients who have higher Body mass index , broad chest and certain other chest conditions.
In such cases , use of additional incision on the hands or in rare instances on the leg are required.
With the robotic technique which has been available with us since 2023, exclusive use of BIMA guarantees all the possible 4 to 5 arterial grafts with no additional incision on any part of the body ( except a 5 to 6 cm on the left side of chest ).
These BIMA are the best arteries available on the body to graft a coronary artery and have shown better long term patency and survival benefit as compared to other arteries.
At the same time , use of robotic access makes the surgery more precise, predictable and safe with excellent graft quality and reduces the rate of damage to surrounding structures.
Conventional Cabg takes around 3 to 4 hours.
With mics and robotic we expect slightly more time as there are additional steps involved.
These are:
1. Special anesthesia pain relief techniques like erector spinae block.. here the cardiac anaesthetist places a small catheter ( after general anaesthesia) in the back of the patient which usually is kept for 72 to 96 hours and administers constant pain relief ..
2. Smaller incision means a slight increase in operative time.
The increased time usually is about 1 to 1.5 hours more in mics and around 2 to 2.5 hrs more in robotic.
Rest assured, as MICS and robotic Cabg is preferred in stable patient it usually is not a significant concern.
In MICS and robotic the recovery is very fast as the tissue damage in the surgery and healing needs of body are reduced by almost 50%.
Absence of bone damage makes life easy as pain due to incision is limited.
There is no restriction on bending down picking up objects from the floor carrruing weights doing simple exercises like yoga bending stretching.
More so patients do not experience pain on twisting turning.
Patients do not have any restrictions of driving no need of chest belt and most importantly no need of long antibiotic treatment to prevent infection as the risk of deep infections even in highly diabetic patients is zero.
With mics and robotic, as there are no restrictions on body movement patients usually are very comfortable and they can start desk job or work from home within 2 weeks of discharge ( in a low stress environment situation).
Early return to function is of utmost importance in younger patients and we have had positive responses from almost all the patients.
