In one year since the inception of its robotics program, Cleveland-based University Hospitals' Harrington Heart & Vascular Institute has performed more than 100 heart bypass surgeries using the Da Vinci surgical robot.
Surgeons Kelsey Gray, MD, and Pablo Ruda Vega, MD, became the first in Ohio to use the technology when the program launched in December 2023. They are now performing eight to 10 robotic procedures per month on average, according to a Dec. 11 news release from University Hospitals.
"Using the robot gives the surgeon more options and more flexibility during the procedure," Dr. Gray said in the release. "Best of all, patients experience less post-operative pain, have a shorter stay in the hospital and return to normal activities more quickly. Our ultimate goal is giving our patients healthier, fuller lives and this approach helps us achieve that."
Mehdi Shishehbor, DO, PhD, president of University Hospitals' Harrington Heart & Vascular Institute, spoke to Becker's about how the program was implemented and the progress they have seen since its inception.
Before they could get started, Dr. Gray and Dr. Ruda Vega brought the idea for a cardiac robotics program to Dr. Shishehbor and University Hospitals leadership.
"They had to assure me and our leadership team that we had a true champion who was willing to take this on and fully pursue the robotic program," Dr. Shishehbor said. "We didn't want it to be a half-hearted or casual approach; it needed to be an intensive effort, starting with an area where we already had a very robust clinical program."
Knowing the Heart & Vascular Institute was performing 1,800 to 2,000 open heart surgeries per year, Dr. Shishehbor said he felt confident that the program had the clinical volume to justify pursuing robotics. Similarly, his confidence in Dr. Gray as the program's champion helped solidify his approval.
"She decided to take this on," he said. "Dr. Gray traveled extensively, learned from others and gained the knowledge needed to establish a clinical program for robotic surgery."
Dr. Shishehbor said Dr. Gray's commitment to learning more about the operational aspects has bolstered the program's success.
"Many organizations that engage in robotic cardiac surgery have to work with a different company for operational support to get their programs off the ground, adding an additional cost of about $100,000," he said. "We didn't do that. We built the program on our own because we had a champion. If you have a strong champion and sufficient volume … you don't necessarily need a third party to guide you step by step."
Outside of the Harrington Heart & Vascular Institute's core team and already robust clinical program, the hospital was prepared to take on the implementation of a robotics program because it already owned one crucial element: a robot.
"We didn't need to make any capital investment," he said. "We already had [a robot] being used here for other procedures; we just wanted to expand its use to cardiac."
Instead, University Hospitals invested in training and education for its surgeons.
"We gave our surgeons time off to travel to high-volume centers, learn from others and bring that knowledge back to our program," Dr. Shishehbor said. "If you're not willing to make that kind of investment — whether you consider it a sunk cost or not — you won't have a successful program."
That investment has paid off, he said, as the Harrington Heart & Vascular Institute is now one of the high-volume centers where cardiology professionals come to learn.
Minimally invasive direct coronary artery bypass procedures were among the first procedures offered by Harrington Heart and Vascular Institute's robotics program. It has since expanded to performing robotic mitral valve surgeries, robotic aortic valve surgeries and other alternative cardiac procedures.
Dr. Shishehbor said the team has already seen benefits to the minimally invasive approach in terms of length of stay and recovery.
"Patients are recovering much faster. We're getting them extubated, walking and out of bed to start physical therapy sooner," he said, adding that data is already showing the program has shortened patient length of stay in the ICU. The team is currently researching the effect a robotic approach has on overall hospital stay length.
"At the end of the day, we want to do these procedures because they help our patients," he said. "There's no reason to do anything if it doesn't help our patients."
Soon more University Hospital patients will have access to advanced cardiac surgery closer to home as the Harrington Heart & Vascular Institute is launching two robotics programs within the system's regional centers in January.
"The excitement among our cardiac surgeons and our heart and vascular leadership is tremendous," Dr. Shishehbor said, specifically acknowledging Dr. Gray and Dr. Ruda Vega's contributions.
"They're truly the champions of this program," he said. "I'm just behind the desk here, pushing things along."