​Site supervisor Ng Hai Chiang (above), 53, can now play badminton and does not need to worry about stress affecting his heart anymore after his robot-assisted heart surgery, which cost $4,000 after subsidies. -- ST PHOTO: LAU FOOK KONG

Robot-assisted surgery is no longer science fiction. Robot arms poking around in your body are now a reality - and they have helped dozens of patients here, including Mr Ng Hai Chiang. 

The 53-year-old site supervisor, who has had a history of heart valve problems since 2004, found his heart condition steadily affecting his lifestyle.
'I worried about everything I did. I got scared for my heart when I got too stressed. When I played badminton, I had to stop if I felt breathless,' he said.

While he was having a routine three-dimensional echocardiogram last year, Mr Ng's doctor at Changi General Hospital found that his heart had grown very large due to his faulty mitral valve.

The mitral valve is found between the left atrium and left ventricle of the heart. It allows blood to flow from the former into the latter but not in the reverse direction.  
Mr Ng was advised to have his mitral valve replaced or repaired and he was referred to the National Heart Centre Singapore (NHCS).

Dr Chua Yeow Leng, a senior consultant for cardiothoracic surgery at NHCS, suggested that he undergo robot-assisted mitral valve repair surgery, which is minimally invasive. The operation took place in June.

The advanced robot system used to assist the surgeon in the procedure is called da Vinci. It comprises four remote controlled operating arms and a console for the surgeon.

The surgeon performs the operation by manipulating the handles on the console, which in turn control the robot arms holding surgical instruments like scalpel blades and scissors.

Although the surgeon is away from the patient at the console, other staff in the operating room like scrub nurses and bedside surgeons hover by the patient's side to assist with surgery and help with tasks like suction and sutures.

Unlike conventional heart surgery, robot-assisted heart surgery does not require the surgeon to cut through the breastbone or sternum, thus reducing recovery time and the risk of post-surgery complications.

Open heart surgery usually requires an opening of 15cm. In robot-assisted surgery, only a 4cm cut into the right side of the patient's body and three 9mm cuts are needed.

The 4cm opening allows the bedside surgeon to help with the surgery and enables a valve ring to be passed into the chest cavity for repair of the mitral valve.

The other three holes allow the three arms of the robot to enter the chest bearing a three-dimensional camera and surgical instruments.

The $1.5 million da Vinci system was brought into Singapore General Hospital (SGH) in 2002. The SingHealth Endowment Fund was approved for subsidising cardiac surgery in January 2006 and the first robot-assisted heart surgery was performed in December 2006. Since then, the NHCS has performed 34 such operations.

Meanwhile, since 2005, surgeons at Mount Elizabeth Hospital have been performing robot-assisted coronary artery bypass grafting and mitral valve repair open heart operations.

Currently, robot-assisted mitral valve surgery at the NHCS does not cost more than conventional procedures as the programme is funded by the SingHealth Endowment Fund.

The four-hour surgery cost Mr Ng about $4,000 after subsidies, which he paid for with Medisave and Medishield.

While robot-assisted surgery enables faster recovery, it carries its own risks similar to conventional surgery. These include atrial fibrillation (an abnormal irregular heart rhythm), bleeding and wound infection.

Asked which patients are eligible for such surgery, Dr C. Sivathasan, senior consultant at the department of cardiothoracic surgery and principal investigator in robotic-assisted minimally invasive cardiothoracic surgery at the NHCS, said: 'At the moment, we select patients without other complications and who require repair of the posterior leaflet of the mitral valve only.

'We need to get over the learning curve before we move on.'

Mr Ng is happy with the results. He said: 'At least now I'm free to do what I want.'

The National Heart Centre has performed 34 robot-assisted heart operations since December 2006. 

Source: The Straits Times © Singapore Press Holdings Limited. Permission required for reproduction.