[HSF] Hybrid operating room
Tea Acuff
tacuff at swbell.net
Thu Nov 8 16:07:27 EST 2007
Tacky, Tacky. Everyone knows that LOS doesn't mean anything.
tea
----- Original Message ----
From: "wftjrtyler at aol.com" <wftjrtyler at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, November 8, 2007 1:41:26 PM
Subject: Re: [HSF] Hybrid operating room
me? Full sternotomy, cardiopulmonary bypass, CABG for my triple vessel disease...... hell, I may even accept aprotinin.
Hmmmmm suppose i could pose that question to my patient who had TECAB yesterday, but he went home this morning bill turner
-----Original Message-----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 7 Nov 2007 7:02 pm
Subject: Re: AW: AW: [HSF] Hybrid operating room
OK - so home many of you who use the robot have residents/fellows - do you EVER let them doing anything with the robot? I spoke to a hard core robot surgeon who told me it take 5-10 years to develop the skills to do robotic cases reasonably. To think this is ever going to make mainstream cardiac surgery in this current training, legal, financial, environment is a hard pill to swallow. Should we just tag on a couple of years more of training? So me the data - any data - that suggests ANY advantage of robot cardiac surgery? People have been talking about it for 10 years now. Same with mini-invasive surgery - yes it may have it's application in very selective patients - but we need to be realistic. Where is the real data that shows mini's are the greatest thing since sliced bread? Yes, some (only some) patients really care or if you have a highly selective patient population like Cohn or Cosgrove (fyi - Lytle does not do mini anythings.)
We dont need to reinvent ourselves, rather I argue we stand our ground and stick to the basics - why? cuz it works. CABG, for example, is still the best treatment for many types of CAD. Do we need to cave to the rampant use of stents in inappropriate situations? I did a hybrid CABG (off pump LIMA-LAD, DES to 2 focal RCA lesions) in a 79 year/old this week - we all believe he got the best treatment. Most of the patients I operate on and happy to be alive - I have not heard too many complaints about my full sternotomy incisions (even in the ones I was not happy with). We need to be honest with what is the best treatment for the best patients and if we stick to that principle, then everyone - the cardiologists, the lawyers, to administrators, and maybe even the patients will be happy.
Have we (I know I have) seen or heard about enough people trying "fancy" stuff only to get in trouble - big trouble.
me? Full sternotomy, cardiopulmonary bypass, CABG for my triple vessel disease...... hell, I may even accept aprotinin.
-michael
On Nov 7, 2007, at 7:30 AM, Ani Anyanwu wrote:
> 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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