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Q&A with Dr Husam Balkhy, Associate Professor of Surgery, Director, Minimally Invasive and Robotic Cardiac Surgery, University of Chicago, USA

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Husam H. Balkhy, MD, is a pioneer in the field of minimally invasive and robotic cardiac surgery. He specialises in the treatment of coronary artery disease, heart valve disorders, atrial fibrillation and other cardiac diseases, using robotic and less invasive techniques. Dr Balkhy is one of only a handful of surgeons in the world with extensive experience in performing robotic totally endoscopic beating heart coronary bypass grafting (TECAB). We met with Dr Balkhy during Arab Health to talk about his vision of robotic surgery. 

Q. Robotic surgery – where do you see it going? 

A. I would hope to see more and more centres offering robotic surgery and more and more patients benefitting from this treatment. The technology has really advanced significantly. The robot technology has been available since 2002 for cardiac procedures, but it’s only recently been able to launch different types of procedures because of the availability of adjunctive technologies that have come to the fore and allowed us to utilise the robot for different specialities. At the moment we are working on the fifth or sixth generation robot, as the hardware has evolved as much as the software that makes it what it is. We are using it on paediatric patients, adult patients, very fragile patients that can’t handle a large incision or would take a long time to heal, patients with added co-morbidities such as liver-and renal failure, and bleeding tendencies. Those patients will definitely benefit from a less invasive approach.

Q. In terms of time, does it mean that you can perform more surgeries in a day? 

A. Actually no, it’s the opposite. Robotic surgery takes a little bit longer. The way I explain it to my patients is: Imagine if you want to rearrange the furniture in your living room and you have two options; one is to bring a bulldozer and knock down the front wall and move your chair and your sofa, it would take two seconds. The other option is to rearrange your furniture by stealthily going in through the window with a machine. That would take a little bit longer, but you are not wrecking the façade of the house.

Q. You do believe that patient education is really important, what is your advice to physicians and surgeons in the same field? 

A. I would say to heart surgeons that are up and coming that now when we have perfected the technique of fixing people’s hearts over the years, coronary bypass surgery, replacing and repairing valves, and treating all sorts of congenital defects, now is the time to try and minimise the trauma and lessen the invasiveness of those treatments. Traditionally, when I trained in heart surgery back in the early

1990s, we had just started to get in to the notion that less invasive is better. Heart surgery is very complex, you have to make sure that the heart beats perfectly and one small miss-step could be extremely devastating. We need to start concentrating on using technology and science in order to offer the same effectiveness but less invasively. That is my goal and mission in life.

I have been a minimally invasive surgeon for the majority of my career. With this approach you have less time for recovery, less complications, less blood loss, and you almost eliminate the spectre of wound infections. The challenge is of course to have the same effectiveness as the traditional, open-heart surgery. This is where training comes in, leveraging new software and technologies; all those things will become very important.

Q. What are you hoping to achieve at Arab Health? 

A. We are hoping to meet surgeons, invite them to come over and do some training and collaboration; basically convey that this is available and that it is something that surgeons can learn. Administrations and hospitals really need to look into this, as this is a saving to society. If you think about it, when you perform open-heart surgery the patient will be out of action for six months, and that is if there are no complications. If you have complications, then you’re looking at a much longer period of recovery. There is also a psychological gain to minimally invasive surgery. Less noticeable incisions, shorter recovery time and a quicker return to normal activities.

Q. Are there any facilities in this region that use this technique? 

A. Yes, there’s one centre in Doha that I visited last year to help proctor. The Cleveland Clinic – Abu Dhabi is planning to do something regionally as well, where at the moment they’re flying people over to the States. The uniqueness about the University of Chicago programme is that we operate on many different types of conditions using the robot, and when we do coronary bypass with the robot we use a ‘beating heart’ technique, meaning that we do not stop the heart. There are some programmes that do use robotics on a coronary heart bypass but they have to stop the heart.

Q. What do you think needs to be done to reduce cardiovascular disease, particularly in this region? 

A. I think a massive awareness and preventive care campaign needs to happen here. Better control of diabetes, smoking cessation programmes, and exercise awareness are probably the three major things that will change the trend that we see in the rise of coronary disease and heart disease in general in this region. I see little glimpses of improvement. It’s very slow, but it is coming. My family is originally from Saudi Arabia and when I return, I am glad to see that there are changes happening. I see people using walkways and taking a proactive approach to their coronary health.