When you need cardiac surgery, robotic and minimally invasive surgery is often an option.
Dr. Jeffrey D. Lee explains the broad range of less invasive options now available to qualifying patients requiring heart bypass, heart valve, or aortic aneurysm surgery.
Selected Podcast
The Comprehensive Robotics and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center
Featured Speaker:
Dr. Jeffrey D. Lee, MD
Dr. Jeffrey D. Lee serves as the medical director of robotics and minimally invasive cardiac surgery at the MemorialCare Heart and Vascular Institute at Saddleback Memorial Medical Center. Board certified by the American Board of Thoracic Surgery and a Fellow of the American College of Surgeons, Dr. Lee has been practicing cardiac and thoracic surgery for over 15 years. He has performed more than 2,000 cardiac surgeries. Dr. Lee graduated from Cornell University and NYU School of Medicine and completed his residencies at UCLA and the Weill-Cornell Medical Center. Pursuing his lifelong passion for robotics and minimally invasive cardiac surgery, Dr. Lee completed 2 years of advanced clinical fellowship training in robotic heart bypass surgery at the University of Maryland and robotic and minimally invasive heart valve surgery at The Cleveland Clinic.Organization: Saddleback Memorial Medical Center
Transcription:
The Comprehensive Robotics and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center
Deborah Howell (Host): Hello and welcome to the show. You’re listening to
Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today’s guest is Dr. Jeffrey Lee, Medical Director of Robotics and Minimally Invasive Cardiac Surgery at the MemorialCare Heart and Vascular Institute at Saddleback Memorial Medical Center, board certified by the American Board of Thoracic Surgery, and a fellow of the American College of Surgeons. Dr. Lee has been practicing cardiac and thoracic surgery for over 15 years. He has performed more than 2,000 cardiac surgeries. Welcome, Dr. Lee.
Dr. Jeffrey Lee (Guest): Well, thank you very much.
Deborah: Today we’re going to talk a bit about the broad range of options now available to qualifying patients who need heart bypass, heart valve, or aortic aneurysm surgery. If you could, please tell us a little bit about the comprehensive robotic and minimally invasive cardiac surgery program at Saddleback.
Dr. Lee: Well, Deborah, the program here is a comprehensive program in that many patients, up to about a third of patients overall requiring heart surgery can oftentimes have one of these minimally invasive robotic options. For cardiac surgery, there are primarily a few problems that we have to deal with, such as aortic valve replacement, mitral valve repair, coronary artery bypass grafting, or treatment of atrial fibrillation. All options, all four of those procedures can oftentimes be performed in a less invasive fashion, and we offer all those options at Saddleback Memorial currently.
Deborah: Which is your preferred session, right? Okay. And which kind of patients would qualify for this program?
Dr. Lee: Primarily patients who have only one problem. Many times, patients have, for example, aortic valve problem and a mitral valve problem and often need to have heart bypass surgery. Those types of patients would be too complex for this type of approach, and we would recommend a traditional approach, which should be traditionally a standard sternotomy incision, which is a midline incision dividing the breastbone in the midline. Usually, it has an incision length of about 10 to 12 inches, but it’s a very safe option for all patients. We’re offering these other programs in these less invasive approaches. It’s just as safe, oftentimes safer. But those would be primarily reserved for patients who will only have, for example, a need for an aortic valve or only have a need for a mitral valve repair.
Deborah: I'm getting a pinch in the line where I’m losing parts of the sentence. I wonder if you’re getting another call or something, doctor?
Dr. Lee: No.
Deborah: I'm losing about a third of each sentence. We’re going to keep going, but we can edit this. I’m just letting you know if there’s a pause, it’s because I can't hear when you’re done speaking, for some odd reason. Okay. What are the different approaches offered, doctor?
Dr. Lee: The different approaches are depending upon the disease that needs to be treated. For example, if a patient needs an aortic valve replacement, we offer a minimally invasive aortic valve replacement, which is essentially a three-inch incision enabling us to gain full access to the heart and replace the aortic valve with a new valve. Oftentimes, patients need a mitral valve surgery, and usually, repair is is oftentimes possible. And we would offer actually three different approaches. One is minimally invasive in such that we are performing a hemisternotomy incision. One is by a right thoracotomy incision, minithoracotomy incision, and one is a robotic approach using the Da Vinci robot to repair the valve. Each approach has different applicability for different patient population. Primarily, how we choose between one or the other for a patient, for example, needing a mitral valve repair, is we have to assess the valve to make sure it’s a clearly reparable valve, and also, that they don’t have significant amount of atherosclerosis, which is hardening of the arteries of the descending aorta. If the patients have a significant amount—and we estimate that based upon the CAT scan, which we would perform preoperatively—then he would not be a good candidate for the robotic approach. He would be better suited for a ministernotomy or hemisternotomy approach.
Deborah: Okay. So if it’s not repairable, you have to replace.
Dr. Lee: Oftentimes, it is repairable. At least 90 percent of mitral valves are repairable.
Deborah: That’s great to know. What are some of the differences between less invasive surgery and traditional surgery other than the size of the incision?
Dr. Lee: Well, the size of the incision, of course, is what the patient sees, and that’s what they clearly are focused on. But I think there are a lot more clinical benefits that maybe aren’t apparent to everybody, including the patient, of course. They’ve actually studied this in the Cleveland Clinic, where I trained, and they found that the less invasive approaches and the robotic approaches are associated with less bleeding after the surgery, less need for blood transfusion after the surgery, a lot less pain, earlier time to getting off the breathing machine, and earlier discharge from the hospital and getting back to work sooner. Traditionally, patients who have a minimally invasive or robotic approach to these types of procedures can be back to work in about two weeks versus the traditional method, which should be at least two to three months.
Deborah: Wow. That’s quite a difference in someone’s life, certainly, if you’re trying to keep your job or if you’re running a company or just trying to stay in the work pool. Are there any published studies that prove the benefits of less invasive cardiac surgery?
Dr. Lee: Yes. Actually, there’s several, and I actually have a website called miniheartsurgery.com, where I post all these articles. And if you go there and see the articles pertaining to what I’m discussing, how, as I mention, the minimally invasive approaches to the mitral valve, the aortic valve are significantly beneficial to the patient in terms of those criteria that I just mentioned.
Deborah: miniheartsurgery.com?
Dr. Lee: www.miniheartsurgery.com.
Deborah: Beautiful. And what are some of the benefits of robotic cardiac surgery over traditional surgery?
Dr. Lee: I think in robotic surgery, it’s quite a revolution for cardiac surgery, and it’s really the ability to repair the valves, specifically for the mitral valve. Robotic mitral valve repair is associated—at least at the Cleveland Clinic, where I trained—with an over 99-percent repair rate. And that’s unheard of with a traditional approach. And I think it’s because of our ability to visualize the valve in three dimensions. And you could imagine, what is a robotic mitral valve repair? It’s actually going through port holes, and instead of making a large incision to put my hand and fit my hand down into the chest, we’re actually placing a three-dimensional camera through this port hole incision and putting me inside the heart, if you will, while I have a console five feet away. They really figure out what’s wrong with the valve and repair it with an incredible success rate of 99 percent.
Deborah: How long do you train on the robotic machinery?
Dr. Lee: I’ve trained over two years with the robot. I’ve done two years of formal fellowship, one at University of Maryland at a robotic heart bypass fellowship, and most recently at the Cleveland Clinic, where I did a robotic and minimally invasive valve fellowship. For over two years, I’ve focused my attention in training on less invasive approaches as well as the robotic heart surgery.
Deborah: I just can't imagine anything more fun than working that camera and getting those results for your patients.
Dr. Lee: Oh my goodness. It’s really revolutionary. The results are so satisfying to us as physicians, and families are just so excited to see their loved ones out of the hospital so soon. And really, it’s a really wonderful approach.
Deborah: Win-win-win. What advice can you give to someone who is researching their options on where to get their heart surgery performed and what kind of heart surgery to undergo?
Dr. Lee: I think depending upon the situation of the patient, obviously, we would welcome them to see us in consultation. But if that’s not possible because of their logistics or whatever, it’s important to just let the surgeon do what he knows best to do. It will be a difficult thing to do. It’s not wise to ask the surgeon, “Can you do a less invasive approach?” when he’s not really experienced in that. So whatever he knows how to do best is what you should have them do. But if you’re able to come here, obviously, I think the best advice is to seek out somebody who has a lot of experience, and if possible, fellowship training in these types of advanced technologies because I think that’s where the rubber hits the road in terms of getting the best clinical results.
Deborah: Absolutely. Trust the experts. You can go online and be informed, but really, when it comes to the decisions, it’s got to be up to the physician team.
Dr. Lee: Right. I think many times patients look online and they say, “Oh, can you do this?” and the surgeon wants to satisfy the patient, so he’ll look up how to do it and he’ll do it. But it just will not be his best clinical result. Let the surgeon do what he knows how to do best. But obviously, if you’re looking for these types of technologies and approaches, go to a center that has a lot of experience with it. And certainly, we have that experience here at Saddleback.
Deborah: And don’t try this at home, right?
Dr. Lee: Yes, not yet.
Deborah: Thank you so much, Dr. Lee. It’s been so informative to have you on the program today to talk to us about the Comprehensive Robotic and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center. Have a wonderful day, sir, and thank you so much for being here.
Dr. Lee: Thank you so much.
Deborah: To listen to the podcast or for more info, please visit memorialcare.org. I’m Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.
The Comprehensive Robotics and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center
Deborah Howell (Host): Hello and welcome to the show. You’re listening to
Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today’s guest is Dr. Jeffrey Lee, Medical Director of Robotics and Minimally Invasive Cardiac Surgery at the MemorialCare Heart and Vascular Institute at Saddleback Memorial Medical Center, board certified by the American Board of Thoracic Surgery, and a fellow of the American College of Surgeons. Dr. Lee has been practicing cardiac and thoracic surgery for over 15 years. He has performed more than 2,000 cardiac surgeries. Welcome, Dr. Lee.
Dr. Jeffrey Lee (Guest): Well, thank you very much.
Deborah: Today we’re going to talk a bit about the broad range of options now available to qualifying patients who need heart bypass, heart valve, or aortic aneurysm surgery. If you could, please tell us a little bit about the comprehensive robotic and minimally invasive cardiac surgery program at Saddleback.
Dr. Lee: Well, Deborah, the program here is a comprehensive program in that many patients, up to about a third of patients overall requiring heart surgery can oftentimes have one of these minimally invasive robotic options. For cardiac surgery, there are primarily a few problems that we have to deal with, such as aortic valve replacement, mitral valve repair, coronary artery bypass grafting, or treatment of atrial fibrillation. All options, all four of those procedures can oftentimes be performed in a less invasive fashion, and we offer all those options at Saddleback Memorial currently.
Deborah: Which is your preferred session, right? Okay. And which kind of patients would qualify for this program?
Dr. Lee: Primarily patients who have only one problem. Many times, patients have, for example, aortic valve problem and a mitral valve problem and often need to have heart bypass surgery. Those types of patients would be too complex for this type of approach, and we would recommend a traditional approach, which should be traditionally a standard sternotomy incision, which is a midline incision dividing the breastbone in the midline. Usually, it has an incision length of about 10 to 12 inches, but it’s a very safe option for all patients. We’re offering these other programs in these less invasive approaches. It’s just as safe, oftentimes safer. But those would be primarily reserved for patients who will only have, for example, a need for an aortic valve or only have a need for a mitral valve repair.
Deborah: I'm getting a pinch in the line where I’m losing parts of the sentence. I wonder if you’re getting another call or something, doctor?
Dr. Lee: No.
Deborah: I'm losing about a third of each sentence. We’re going to keep going, but we can edit this. I’m just letting you know if there’s a pause, it’s because I can't hear when you’re done speaking, for some odd reason. Okay. What are the different approaches offered, doctor?
Dr. Lee: The different approaches are depending upon the disease that needs to be treated. For example, if a patient needs an aortic valve replacement, we offer a minimally invasive aortic valve replacement, which is essentially a three-inch incision enabling us to gain full access to the heart and replace the aortic valve with a new valve. Oftentimes, patients need a mitral valve surgery, and usually, repair is is oftentimes possible. And we would offer actually three different approaches. One is minimally invasive in such that we are performing a hemisternotomy incision. One is by a right thoracotomy incision, minithoracotomy incision, and one is a robotic approach using the Da Vinci robot to repair the valve. Each approach has different applicability for different patient population. Primarily, how we choose between one or the other for a patient, for example, needing a mitral valve repair, is we have to assess the valve to make sure it’s a clearly reparable valve, and also, that they don’t have significant amount of atherosclerosis, which is hardening of the arteries of the descending aorta. If the patients have a significant amount—and we estimate that based upon the CAT scan, which we would perform preoperatively—then he would not be a good candidate for the robotic approach. He would be better suited for a ministernotomy or hemisternotomy approach.
Deborah: Okay. So if it’s not repairable, you have to replace.
Dr. Lee: Oftentimes, it is repairable. At least 90 percent of mitral valves are repairable.
Deborah: That’s great to know. What are some of the differences between less invasive surgery and traditional surgery other than the size of the incision?
Dr. Lee: Well, the size of the incision, of course, is what the patient sees, and that’s what they clearly are focused on. But I think there are a lot more clinical benefits that maybe aren’t apparent to everybody, including the patient, of course. They’ve actually studied this in the Cleveland Clinic, where I trained, and they found that the less invasive approaches and the robotic approaches are associated with less bleeding after the surgery, less need for blood transfusion after the surgery, a lot less pain, earlier time to getting off the breathing machine, and earlier discharge from the hospital and getting back to work sooner. Traditionally, patients who have a minimally invasive or robotic approach to these types of procedures can be back to work in about two weeks versus the traditional method, which should be at least two to three months.
Deborah: Wow. That’s quite a difference in someone’s life, certainly, if you’re trying to keep your job or if you’re running a company or just trying to stay in the work pool. Are there any published studies that prove the benefits of less invasive cardiac surgery?
Dr. Lee: Yes. Actually, there’s several, and I actually have a website called miniheartsurgery.com, where I post all these articles. And if you go there and see the articles pertaining to what I’m discussing, how, as I mention, the minimally invasive approaches to the mitral valve, the aortic valve are significantly beneficial to the patient in terms of those criteria that I just mentioned.
Deborah: miniheartsurgery.com?
Dr. Lee: www.miniheartsurgery.com.
Deborah: Beautiful. And what are some of the benefits of robotic cardiac surgery over traditional surgery?
Dr. Lee: I think in robotic surgery, it’s quite a revolution for cardiac surgery, and it’s really the ability to repair the valves, specifically for the mitral valve. Robotic mitral valve repair is associated—at least at the Cleveland Clinic, where I trained—with an over 99-percent repair rate. And that’s unheard of with a traditional approach. And I think it’s because of our ability to visualize the valve in three dimensions. And you could imagine, what is a robotic mitral valve repair? It’s actually going through port holes, and instead of making a large incision to put my hand and fit my hand down into the chest, we’re actually placing a three-dimensional camera through this port hole incision and putting me inside the heart, if you will, while I have a console five feet away. They really figure out what’s wrong with the valve and repair it with an incredible success rate of 99 percent.
Deborah: How long do you train on the robotic machinery?
Dr. Lee: I’ve trained over two years with the robot. I’ve done two years of formal fellowship, one at University of Maryland at a robotic heart bypass fellowship, and most recently at the Cleveland Clinic, where I did a robotic and minimally invasive valve fellowship. For over two years, I’ve focused my attention in training on less invasive approaches as well as the robotic heart surgery.
Deborah: I just can't imagine anything more fun than working that camera and getting those results for your patients.
Dr. Lee: Oh my goodness. It’s really revolutionary. The results are so satisfying to us as physicians, and families are just so excited to see their loved ones out of the hospital so soon. And really, it’s a really wonderful approach.
Deborah: Win-win-win. What advice can you give to someone who is researching their options on where to get their heart surgery performed and what kind of heart surgery to undergo?
Dr. Lee: I think depending upon the situation of the patient, obviously, we would welcome them to see us in consultation. But if that’s not possible because of their logistics or whatever, it’s important to just let the surgeon do what he knows best to do. It will be a difficult thing to do. It’s not wise to ask the surgeon, “Can you do a less invasive approach?” when he’s not really experienced in that. So whatever he knows how to do best is what you should have them do. But if you’re able to come here, obviously, I think the best advice is to seek out somebody who has a lot of experience, and if possible, fellowship training in these types of advanced technologies because I think that’s where the rubber hits the road in terms of getting the best clinical results.
Deborah: Absolutely. Trust the experts. You can go online and be informed, but really, when it comes to the decisions, it’s got to be up to the physician team.
Dr. Lee: Right. I think many times patients look online and they say, “Oh, can you do this?” and the surgeon wants to satisfy the patient, so he’ll look up how to do it and he’ll do it. But it just will not be his best clinical result. Let the surgeon do what he knows how to do best. But obviously, if you’re looking for these types of technologies and approaches, go to a center that has a lot of experience with it. And certainly, we have that experience here at Saddleback.
Deborah: And don’t try this at home, right?
Dr. Lee: Yes, not yet.
Deborah: Thank you so much, Dr. Lee. It’s been so informative to have you on the program today to talk to us about the Comprehensive Robotic and Minimally Invasive Cardiac Surgery Program at Saddleback Memorial Medical Center. Have a wonderful day, sir, and thank you so much for being here.
Dr. Lee: Thank you so much.
Deborah: To listen to the podcast or for more info, please visit memorialcare.org. I’m Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.