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Doctors Medical Center Transforming Heart Surgery in California

The surgical team at Doctors Medical Center (DMC) in Modesto, California, recently performed a successful robotic-assisted, minimally-invasive, direct vision coronary artery bypass graft (MIDCAB) surgery. The multi-vessel surgery may be a first in the region, and possibly in the state of California. The patient was able to return home after two days and is recovering well. 

Robotic coronary artery bypass graft (CABG) surgery, in contrast to open-heart bypass surgery, is a minimally invasive procedure that uses a high-technology robot (commonly called “the da Vinci,” after the manufacturer’s name). This physician-controlled device executes the surgical steps through small incisions between the ribs via the da Vinci’s robotic arms and a camera that allows for direct vision of the procedure. The robotic arms manipulate tiny instruments and have the advantages of greater range of motion and more precision than a surgeon's unassisted movements. 

"This is the first minimally-invasive multi-vessel CABG in the region, to my knowledge,” said Dr. Dan Bethencourt, M.D., assistant clinical professor of surgery at Stanford University Medical School's Department of Cardiothoracic Surgery. “Using the da Vinci to mobilize the left internal mammary artery is notable, as it can be expected to greatly reduce pain during recovery."   

Pete Carnegie, the CEO of Minimally Invasive Solutions – a national company that trains physicians to use the da Vinci robot for MIDCAB surgery – believes that the procedure might not only be the first in the Central Valley, but it may also be the first multi-vessel robotic assisted MIDCAB in California. 

“To the best of my knowledge of the robotic cardiac market in the USA, this surgery performed at DMC is the first robotic multi-vessel MIDCAB in California,” said Carnegie. “The majority of robotic cardiac programs in the USA only do one graft.” 

Indeed, the robotic CABG surgery at DMC was particularly intricate. The surgeon was able to harvest the LIMA with the robot and then performed a mini-thoracotomy – also known as video-assisted thoracic surgery (VATS) – that utilized the LIMA and vein grafts to perform a two-vessel bypass for this patient. 

“Three grafts are remarkable in that patients with multiple blocked coronary arteries can come to Doctors Medical Center and potentially receive a multivessel CABG without having a sternotomy [open heart surgery],” said Carnegie. “This could create an opportunity to help many of the sicker patients who would not be candidates for a sternotomy but who need the life-saving CABG procedure.”