AW: AW: [HSF] Hybrid operating room

Wed Nov 7 12:30:28 EST 2007

Dr Zhou

I agree with all you say. The days of a 20 cm sternotomy belong to the 1970s and if we do not reinvent ourselves we will perish. Unfortunately the majority of surgeons belong to the past and for various reasons we will remain there. As I said we do not do any robotic cardiac surgery (like you our robot is fully utilized by the pelvic surgeons. Our faculty member who used to do the robotic surgery left last year and we have done none since. I would like to embrace these alternative approaches but unfortunately I do not have a CABG practice.

My point about none of us will have a hybrid was that while some may chose PCI and some may chose CABG it is extremely unlikely that any cardiac surgeon would opt for a mix of PCI and CABG. If one is having a CABG why not bypass everything? If one is averse to sternotomy, there are surgeons like yourself who could take down both mammaries with a robot and do a complete revascularization through small thoracotomy.

Ani

PS - will you be posting a video of your non-sternotomy AVRs too? You did not comment specifically but I presume the pneumonectomy in michaels's patient is a contraindication to this approach?

> Date: Tue, 6 Nov 2007 19:45:03 -0500> From: zzhoumd at pol.net> Subject: Re: AW: AW: [HSF] Hybrid operating room> To: OpenHeart-L at lists.hsforum.com> CC: > > Dear Ani,> > There are many things changed since 1996. First, stents are getting better. > Second, robotic assisted IMA taken down is very successful and quick as > robotic technology is getting better. I have done MIDCAB through thoracotomy > without robot. It is not easy, therefore, it is not widely accepted. I can > now take down both IMA in short period time with robot. I just submitted a > video to CTSNET but it is not officially accepted yet. I hope you can see it > once it is available.> > The ideal candidate for such patients are proximal LAD lesion, or complex > LAD+Diag lesion, with type A or B lesion in RCA and/or Cx. There are not > that many of them. I think average about 1-2 case per week now. However, I > do see the number is increasing.> > The interest of robotic technology is actually driven by patients and other > physicians, believe or not. If you look at many cardiac surgeons, the choice > between stents and surgery is clear. Although we think surgery is better, > more cardiac surgeons have stents placed in themselfs. When come to less > invasive vs more invasive, less invasive wins most of the time. Stent is an > inferor technology to bypass surgery. However, more patients would rather > have stent then surgery. In real life, people prefer less invasiveness with > acceptable quality. Our cardiologists stent 3 vessel disease all the time, > and most of the time, it was incomplete revasculization. They will stent 1-2 > vessel and leave 1-2 vessel still occluded. Most of the stent nowdays in US > (~60%) are "off label use".> > Althogh we can blame the cardiologiets using too many stents, a large skin > incision with sternotomy and cardiopulmonary bypass is a "hard sell" if the > patient think he can get away with stents.> > Z Zhou> > > > > > ----- Original Message ----- > From: "Ani Anyanwu" <anianyanwu at hotmail.com>> To: <openheart-l at lists.hsforum.com>> Sent: Tuesday, November 06, 2007 8:55 AM> Subject: RE: AW: AW: [HSF] Hybrid operating room> > > Hal> > I do not actually disagree with need for a hybrid suite.> > I was merely asking how his team have justified it to the hospitals as it is > almost certainly going to be an underutilized and unprofitable investment. > Our attempts to get funding for such a suite in our hospital have been > unsuccessful. Of course I and every cardiac surgeon in the world would like > to have a high tech hybrid suite but there are also a lot of other things we > would like to have but it does not imply a justifiable or appropriate way to > spend healthcare resources.> > The justification in investing in these ORs is based on anticipated future > needs. However thus far these anticipations have not been realized and > remain in the future rather than present. Mind you, hybrid revascularization > is not a new concept. Gianni Angelini in the UK reported the world's 'first' > combined angioplasty and 'keyhole' LIMA CABG in 1996 (Lancet 1996;347:757-8) > and was quoted in the lay media as saying "The procedure is set to transform > heart surgery, and I believe it will lead to a reduction of as much as > 20-40% in the number of conventional bypass. In a few years' time everyone > will be doing it" (BMJ 1997;315:104-107). Ten years later however hybrid > revascularization constitutes not even 1% of coronary revascularization > procedures and other than a few nobody is doing it - even in Angelini's > centre, it remains a minority procedure. The same applies to other hybrid > approaches such as for aortic arch replacement and also to robotic assisted > CABG - the anticipated explosion in such procedures has not taken off almost > a decade after initial suggestion - these increase in numbers are awaited to > the present day.> > The reality though is that our (and our hospital's) interest in hybrid > procedures is driven primarily not by interest for the patient (none of us > would have a hybrid revascularization) but by commercial, economic, > professional or institutional interests. While I have my doubts as to the > place for hybrid revascularization, I do agree with a drive to have such > ORs. Time however will tell whether the investment has been worthwhile.> > > Ani> > > > > > > From: Hgrmd at aol.com> Date: Tue, 6 Nov 2007 06:40:17 -0500> Subject: Re: > > AW: AW: [HSF] Hybrid operating room> To: OpenHeart-L at lists.hsforum.com> > > CC: > > Dear Dr. Zhou,> Where are you practicing? Unlike Ani, I agree with > > you for the need of a > hybrid suite. Just because you don't use the > > room's capability every case, > you will need to have that option. > > > > Hal> > > > ************************************** See what's new at > > http://www.aol.com> _______________________________________________> > > OpenHeart-L mailing list> > Send postings to:> > > OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, > > or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> -----------------------------------------> _________________________________________________________________> Get free emoticon packs and customisation from Windows Live.> http://www.pimpmylive.co.uk_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and> disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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