Another canadian first

On May 4, 2007, at LHSC's University Hospital, a cardiac surgery team led by Dr. Bob Kiaii, cardiac surgeon, performed Canada's first totally endoscopic closed-chest bypass surgery on a patient's beating heart. Using CSTAR's (Canadian Surgical Technologies & Advanced Robotics) da Vinci robot, the surgical team made only four one-centimetre incisions to perform the bypass surgery.

Previously, the team required a working incision of four to five centimetres as well as three one-centimetre incisions to perform coronary artery bypass surgerya method that required a three-day hospital stay and four-to-six-week recovery period. This latest advance reduces the hospital stay to one to two days, and the recovery period to about one week.

In conventional coronary bypass surgery, the heart is stopped, andthe patient is connected to a heart-lung machine during the procedure. An 18 to 20 centimetre incision is made and the breastbone cut to expose the heart. Patients typically stay in hospital for five to six days and require three months to recover.

Dr. Kiaii credits the cohesiveness of the cardiac surgery team for the steady advances being achieved at LHSC in the field of robotic-assisted cardiac surgery. "It has enabled us to go through the painstaking work required to reach a number of milestones." Members of the team include the anesthetist, respiratory therapist, surgeon, surgical assistant, nursing staff, and robotics technicians.

In 2004, the team was the first in North America to complete minimally invasive robotic-assisted heart bypass surgery and angioplasty with stenting at the same time in the operating room. It now leads the world in the number of times, more than 70, that it has performed this hybrid procedure.

Former LHSC cardiac surgeon Dr. Douglas Boyd performed the world's first robotic-assisted, closed-chest cardiac single bypass procedure on a beating heart at LHSC's University Hospital in 1999 in what Dr. Kiaii says was, "probably one of the biggest breakthroughs in cardiovascular medicine." Building on this strong legacy, LHSC cardiac surgeons, along with a dedicated surgical team, have achieved another six significant milestones in robotic-assisted coronary surgery since then.

Closed-chest cardiac surgery is not suitable for all patients who require bypass surgery. It is more likely to be an option for selected individuals with specific blocked arteries of the heart.

Today, robotic-assisted surgery is the norm for Dr. Bob Kiaii, who estimates that 85 to 90 percent of the operations he performs incorporate robotics. The team routinely performs robotic-assisted heart valve repairs, reducing patients' hospital stays from seven to ten days to just three or four.

Dr. Kiaii first trained in robotic surgery here in London, with Dr. Boyd. He returned to LHSC in 2003, after pursuing training opportunities in other centres, including a year in Germany. As LHSC began to build CSTAR, Dr. Kiaii built his team. From July to November that year, the team trained in the laboratory setting. It would be only a year later that the team would achieve a North American first.

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