In 2024, cardiac surgeons at NewYork-Presbyterian and Columbia launched a program offering robotic cardiac surgery to children as young as 6 years old. To date, the program has successfully performed robotic procedures to address atrial septal defects, partial anomalous pulmonary venous return, mitral valve conditions, and double aortic arch in children.
Led by Arnar Geirsson, M.D., director of the Cardiovascular Institute and the Surgical Heart Valve Program at NewYork-Presbyterian and Columbia, and Andrew Goldstone, M.D., Ph.D., surgical director of heart transplant and mechanical circulatory support and pediatric heart valve transplantation, the program combines experience in congenital and pediatric cardiac surgery with robotic expertise. Additionally, Emile Bacha, M.D., chief of the Division of Cardiac, Thoracic, and Vascular Surgery at NewYork-Presbyterian and Columbia and director of Congenital and Pediatric Cardiac Surgery at the NewYork-Presbyterian Congenital Heart Center, is a strong supporter of the development of this program.
“The pediatric cardiac robotic program is a truly novel initiative that allows our young patients to avoid a sternotomy and to go home sooner after surgery with much less pain and discomfort,” says Dr. Bacha.
NewYork-Presbyterian and Columbia is the first program in the U.S. dedicated to performing robotic cardiac procedures on children, utilizing a dedicated pediatric surgical team to routinely perform robotic surgeries.
“For children born with congenital heart diseases, this program expands treatment options that can vastly improve their recovery time and quality of life,” Dr. Goldstone says.
Benefits of Robotic Surgery
Robotic cardiac surgery is appropriate for a range of conditions affecting children, including atrial septal defects, partial anomalous pulmonary venous return, and Scimitar syndrome. Mitral valve repair and tricuspid valve repair, which are common adult procedures involving the surgical robot, can also be performed safely on children.
Performing these procedures robotically offers several benefits. It is generally less invasive, leads to less bleeding and surgical complications, and has a decreased length of hospitalization. But for pediatric patients in particular, the ability to undergo cardiac surgery with minimal scarring is significant.
“For some pediatric patients, the scar that results from a sternotomy can bear a psychological burden,” Dr. Goldstone says. “There is research that shows cardiac scarring can have a negative impact on a child’s body image and their mental health.”
There are also potential benefits in pain reduction. Other minimally invasive approaches to open heart surgery involve a vertical incision that can be more painful than open approaches like sternotomy. But using the surgical robot, surgeons can perform the procedure without opening the space between the ribs, reducing postoperative pain for patients.
Patient selection is critical when considering robotics. Patients are evaluated with chest X-ray and CT scan to measure the amount of space available within the chest, and with ultrasound to measure the size of heart vessels. “If a patient is determined to be a good candidate, then robotic surgery would really be the best approach because it’s so much less invasive,” Dr. Goldstone says.
Building on the Robotic Cardiac Surgery Program
The pediatric program is part of the larger Robotic Cardiac Surgery Program at NewYork-Presbyterian and Columbia, which launched in September 2023 under the direction of Dr. Geirsson. In its first year alone, surgeons performed more than 100 robotic cardiac procedures.
For adults, a robotic surgical system is used to provide minimally invasive cardiac surgery and reconstructive valve surgery with a shorter hospital length of stay and a quicker return to daily activities.
The robot has two surgical consoles, allowing the surgeons and trainees to work side-by-side.
The pediatric program follows the same blueprint for success, utilizing a dedicated team of specially trained operating room nurses, along with a pediatric perfusion team and a pediatric anesthesiology team.
Traditionally, technology and a lack of training have limited the number of surgeons performing robotic cardiac surgery in children, but the new focus on robotics at NewYork-Presbyterian and Columbia aims to change that trend.
Dr. Geirsson says he anticipates that advances in tools and techniques will allow the team to take on even more advanced cases over time. Manufacturers are already fine-tuning surgical robots so that the arms can be modified for the small size of pediatric patients and redesigning aortic clamps to better function for children.
“I think this will be offered more and more, especially for kids who are appropriate candidates for it, so they can avoid sternotomy,” Dr. Geirsson says.
