Dr. Marmureanu on the Benefits of Minimally Invasive and Robotic Procedures

Nowadays, more and more people opt for minimally invasive surgery to treat their heart or lung diseases, as these procedures entail a series of considerable benefits such as a shorter recovery period, a lower risk of subsequent complications and significantly smaller incisions. Dr. Alexander Marmureanu has a special expertise in minimally invasive surgery, as well as in robotic surgery, and has performed thousands of cardiac and thoracic interventions using these innovative approaches over the course of his 20-year career.

Dr. Marmureanu annually treats over 500 patients who suffer from lung disease and nearly 300 people diagnosed with cardiac affections, a large number of which choose to undergo minimally invasive or robotic procedures. However, not all patients are suitable candidates for these types of surgery. Factors such as the complexity of their condition, the particularities of their case, their age and their overall health play a crucial role in deciding whether one should undergo minimally invasive or robotic surgery.

Minimally Invasive Surgery vs. Robotic Surgery

Unlike traditional surgery, minimally invasive procedures involve multiple small incisions and the use of an endoscope - a thin, flexible tube with a fiber optic camera attached which constantly provide the surgeon with detailed and magnified imagines of the inside of the body. The endoscope is inserted through one of the incisions, while the medical instruments required to perform the surgery are introduced through the others. Even though minimally invasive interventions might take longer to complete, the benefits are numerous and substantial, including:

  • a faster recovery period - patients who underwent minimally invasive procedures typically recover twice as fast as those who had conventional surgery
  • a shorter hospitalization time - as people who had minimally invasive surgery recover faster, the duration of their hospital stay will be reduced as well
  • smaller, less visible incisions - the incisions involved in this type of surgery are usually a few millimeters long and the wounds tend to fade quickly
  • reduced risk of postoperative complications - due to the nature of minimally invasive procedures, less trauma is inflicted on the internal tissues and consequently, the risk of complications is very low

Although nearly all heart and lung diseases can be treated by minimally invasive surgery, not all patients can successfully undergo this type of intervention, as every case is unique and needs an individualized approach. Your surgeon will be able to determine whether you are a suitable candidate following a series of tests and examination procedures aimed at evaluating your condition. However, the following affections can usually be resolved by minimally invasive surgery:

  • coronary artery disease
  • valve regurgitation
  • lung tumors
  • interstitial lung disease
  • pleural effusion

Robotic surgery also entails a minimally invasive approach. Nevertheless, it is a very innovative technique performed with the aid of the da Vinci Surgical System. During a robot-assisted procedure, thin, metallic arms are introduced in the problematic region of the body through small incisions and the surgeon permanently controls their movements from a console. "The da Vinci platform is a very intelligent device. People need to acknowledge that it is not the robot that operates on them, it is still the surgeon from a console, who emerges himself in the 3D field. The patient is situated 10-15 feet away from the robotic device while another surgeon supervises the entire process", Dr. Marmureanu says.

In addition to the aforementioned benefits of minimally invasive approaches, robot-assisted surgery is a wireless procedure and thus can be performed remotely. The da Vinci System can efficiently operate on a patient located up to 4,000 kilometers from the device. Robotic surgery can be performed for a wide variety of cardiac and thoracic interventions, including:

  • the resection of small malignant tumors
  • mitral valve repair or replacement
  • pericardial window
  • single vessel heart bypass

However, it is mostly employed for lung surgery than for heart procedures, as Dr. Marmureanu notes. "Every procedure in the chest can be done with the da Vinci System. Less difficult cases are the most appropriate for robotic surgery. For lung disease, robotic surgery is not very different from video-assisted thoracoscopic surgery", the surgeon says. For complex procedures, traditional surgery is generally necessary.

Minimally Invasive Mitral Valve Repair/Replacement

Mitral valve repair or replacement can be effectively performed using a minimally invasive approach in most cases. "Instead of doing the regular sternotomy where we open the breastbone, put the retractor and open the heart, we can make a very small, minimally invasive thoracotomy on the right side and use a video-assisted or robotic approach. The space is quite small, but the incision will be big enough to allow a mitral valve repair or replacement", Dr. Alexander Marmureanu explains.

Minimally Invasive Aortic Valve Repair/Replacement

The aortic valve can be successfully repaired or replaced with an artificial implant by undergoing minimally invasive surgery as well. "A small horizontal incision is made in the upper right region of the chest. It entails a reduced exposure of the tissues but the incision is big enough to complete the procedure. Moreover, the patient experiences less pain and a faster recovery", cardiothoracic surgeon Alexander Marmureanu says. The tricuspid and pulmonary valves can also be attended to using a minimally invasive approach.

Minimally Invasive Heart Bypass Surgery

Despite the complexity and difficult nature of this procedure, a heart bypass can also be achieved performing a minimally invasive intervention. Nevertheless, only patients who need a single vessel bypass are eligible for the minimally invasive approach, as its difficulty level is lower. "A small anterolateral thoracotomy is done on the left side of the chest", Dr. Marmureanu explains. In this case, cardiac bypass surgery is often performed off-pump, on a beating heart. "Beating heart surgery is a bit more demanding. Not all types of cases are amenable to this kind of surgery but it is very beneficial when applicable", the surgeon says.

Minimally Invasive Lung Surgery

According to Dr. Alexander Marmureanu, most lung surgeries are performed using a minimally invasive approach. Similarly, the procedure involves the employment of an endoscope equipped with camera, which allows the surgeon to see inside of the body and the incisions required for the thoracotomy are very small. When asked about his personal approach to minimally invasive lung surgery, Dr. Marmureanu explained: "There is no procedure that goes the same and every patient is different. Surgery is always an unpredictable process. The surgeon needs to be fast and precise, quick but thorough. I also try to make the incisions as small as possible for a better recovery."