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About The Center

Stony Brook University Heart Center
Stony Brook University Heart Center
Health Sciences Drive
Stony Brook, NY 11794
SBU Heart Center Phone 631-44-HEART (444-3278)
SBU Heart Center Fax n/a
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Services & Procedures

Da Vinci robotically-assisted CABG

Performing Minimally Invasive Robotically-Assisted Coronary Bypass Surgery

Da Vinci
More than half a million coronary bypass operations are performed each year in the United States to fix clogged arteries and improve blood flow to the heart. At Stony Brook University Medical Center — home of the only heart surgery program in Suffolk County — we have provided the best possible surgical care for many thousands of patients needing a coronary bypass, since 1980, when our cardiothoracic surgery service was established.

Traditional "open heart" coronary bypass surgery involves stopping the heart to perform the procedure and using cardiopulmonary bypass (CPB); that is, routing the blood through the heart-lung machine to maintain the patient while the heart is stopped. It also requires a large incision and splitting the sternum (breastbone), resulting in a large scar and a lengthy recovery time.

The mid-1990s saw the advent of the minimally invasive approach to coronary revascularization called "beating heart" surgery, also known as "off pump" surgery. This new approach avoids the use of the heart-lung machine. Consequently, patients do not experience the inflammatory response caused by CPB, which disrupts the body's physiologic balance.The minimally invasive direct coronary artery bypass (MIDCAB) beating heart procedure was developed at that time, in addition to other off pump procedures.

Patients needing bypass procedures involving one or two vessel grafts could undergo MIDCAB instead of traditional bypass surgery. Using smaller incisions and not requiring the sternum to be split open, MIDCAB produces less trauma, less pain, and faster recovery. Now, as a leader in minimally invasive heart surgery, our cardiothoracic surgery service performs robotically-assisted MIDCAB, which constitutes an improvement over the original MIDCAB that requires a five-inch incision and spreading the ribs for access to the heart.

The new robotically-assisted procedure allows the surgeon to optimize the preparation of the internal mammary arteries, the best vessels for bypass grafts, which produce the most reliable, most protective, and longest-lasting treatment of coronary artery obstruction. Twenty and twenty-five year bypass patency is not uncommon.

MIDCAB Benefits

  • Avoidance of heart-lung machine
  • Best possible quality of bypass grafts
  • Smaller incisions
  • Less pain and scarring
  • Less risk of infection
  • Less anesthesia
  • Less blood loss and fewer transfusions
  • Shorter hospital stay
  • Faster recovery
  • Quicker return to normal activities

Using the Robot

Da Vinci First of all, the surgeon performs the operation using the robot — not the other way around. The da Vinci robotic system is high-tech equipment designed to expand the surgeon's capabilities and offer a minimally invasive option for major surgery, such as coronary bypass surgery.

The surgeon sits in a console equipped with controls that direct the robot's arms to perform the surgery. The robotic arms are very agile, and work as an extension of the surgeon's hands.

With da Vinci, small incisions are used to introduce miniaturized wristed instruments and a high-definition three-dimensional camera. The surgeon, thus, can view a magnified, high-resolution three-dimensional image of the surgical site. At the same time, state-of-the-art robotic and computer technologies scale, filter, and seamlessly translate the surgeon's hand movements into precise micro-movements of the da Vinci instruments.

The system cannot be programmed, nor can it make decisions on its own. Rather, the da Vinci robot requires that every surgical maneuver be performed with direct input from the surgeon. Indeed, the surgeon is controlling every aspect of the operation.

To perform robotically-assisted MIDCAB, three or four small (half-inch) incisions are first made between ribs — for inserting the robot's arms, the video camera, and the surgical instruments — to enable the surgeon to prepare the mammary artery graft(s). Then, a two-inch incision, also between ribs, is made for suturing the artery graft to the heart directly by hand. The heart continues to beat during the surgery, and no heart-lung machine is required.

The superior viewing system and wristed instruments of da Vinci allow the surgeon to operate with greater precision, resulting in fewer complications and potentially better outcomes, compared with conventional MIDCAB — outcomes far better than those achieved with traditional "on pump" coronary bypass surgery.

Patients who undergo robotically-assisted MIDCAB can be discharged from the hospital as early as the second postoperative day.

Important Note:

The Stony Brook Medicine University Physicians website is primarily an informational and educational resource. It should not be used in place of medical advice and recommendations you receive from your health care provider. If you have, or suspect that you have a medical problem or condition, please seek the advice of your health care provider.

Stony Brook Medicine University Physicians provides marketing advice and consultation to the clinical Faculty associated with the University Faculty Practice Corporations (UFPCs). It does not provide medical care directly or indirectly nor does it oversee, direct, manage or supervise the medical care provided by any of the individual Practices. The individual Practices are responsible for the medical care each Practice provides to its patients. Please note that the Practices listed below are separate University Faculty Practice Corporations (UFPCs).