Pushing the Field of Robotic Surgery Forward
In 2012, fresh out of completing her subspecialty training at Brigham and Women’s Hospital, Dr. Mick’s cardiothoracic surgery career began at Cleveland Clinic. During her eight years there, she grew her expertise in mitral valve repair and helped fuel growth of robotic cardiac surgery.
“I always had an interest in the mitral valve and in minimally invasive surgery, and I wanted to learn robotics as it was the latest technological innovation at the time,” says Dr. Mick. “I started training in it when nobody knew what its future was going to be. At our surgical meetings, there used to be heated debates over whether robotic mitral valve repair was a useful and viable way of doing things. Now, it’s considered state of the art, and I was excited to be involved when it was just getting off the ground.”
Dr. Mick trained under some of the earliest experts in robotic surgery at Cleveland Clinic, building her technical expertise and conducting research that helped shape the field. In 2015, she authored one of the first and largest studies comparing use of del Nido cardioplegia versus Buckberg cardioplegia, which are solutions used to arrest and protect the heart during valve surgery. Robotic surgery is what inspired Dr. Mick’s interest in del Nido cardioplegia, as its dosing interval allows robotic surgery to proceed without the kind of frequent interruptions for redosing required in other types of cardioplegia.
The data showed that the del Nido solution, previously only used in pediatric patients, was a safe and effective alternative to the Buckberg solution (one common standard at the time) across open, minimally invasive, and robotic procedures. Establishing this safety paved the way for its use in robotic procedures, and this refinement in the conduct of these cases facilitated robotic cardiac surgery’s growth. “It was the most important study I have done,” says Dr. Mick. “It changed surgical practice all over the world and has generated significant follow-up research and discussion.”
While at the Cleveland Clinic in 2018, the robotic team, including Dr. Mick, performed an analysis on the first 1,000 consecutive cases of robotic mitral valve repair at Cleveland Clinic, demonstrating the technology’s efficacy, safety, and improvements in factors such as procedure times, transfusion times, stroke risk, and more. This data helped to establish the importance of a screening algorithm based on preoperative imaging (e.g., transthoracic echocardiography, CT angiography, and coronary imaging) to aid patient selection for robotic mitral valve surgery, a key component for success.
Dr. Mick says the collective findings from the research she was involved in helped move the needle on the perception of robotic mitral valve repair in the industry. “Cardiac surgeons are very conservative about making technical changes in their operations for good reason, because any missteps in their cases can mean life or death,” she says. “When a surgeon is trying to learn a new skill and the cost of learning new skills is potentially threatening people’s lives, it can make them nervous about adopting a whole technology. These studies consistently demonstrated excellent results over many cases, which is one of the main reasons robotic surgery is accepted now.”
Returning to Her Roots to Build a Team-Based Program
In 2019, Dr. Mick was recruited to lead the robotic cardiac surgery program at NewYork-Presbyterian and Weill Cornell Medicine. “I was excited to return because I’d done my training here,” says Dr. Mick, who attended Weill Cornell Medicine for medical school and did her internship and residencies at NewYork-Presbyterian. “One of my considerations when deciding to move to another institution was ensuring that I could continue to maintain the quality of care that I was accustomed to, both inside and outside of the operating room. I was able to do that by coming to NewYork-Presbyterian and Weill Cornell Medicine. I am lucky to have a high-quality ICU and a supportive team here that routinely achieve great outcomes.”