Dr. Nguyen serves as chief medical executive, director of minimally invasive valve surgery and Barry T. Katzen medical director endowed chair at the institute, which is part of Miami-based Baptist Health South Florida.
A crucial part of building the program included partnering with Florida International University, also in Miami, to recruit renowned cardiac surgeon Makoto Hashimoto, MD, in December.
Drs. Hashimoto and Nguyen recently spoke to Becker’s about the program and what they see for the future of robotic cardiac surgery.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What role does robotic-assisted surgery play in your overall vision for the Baptist Health Miami Cardiac & Vascular Institute?
Dr. Tom Nguyen: Within the short amount of time since Dr. Hashimoto has started, the robotic heart surgery program has exploded. We’re now the largest, highest-volume robotic heart surgery program in the state of Florida and we’re only going to continue to grow.
The vision is to continue to support Dr. Hashimoto, to continue to scale and grow, and for some of our other surgeons to adopt and learn robotic heart surgery. We believe in scalability, scaling and training others. So another part of the vision is to eventually become a robotic heart surgery training center so that other people can learn this technique.
Eventually, as an institute, we want to be a Mecca for the least invasive way of doing complex operations while still achieving excellent outcomes. That’s ultimately our goal and I think robotics will clearly play a role.
Q: What barriers are currently preventing wider adoption of robotics for cardiac procedures?
Dr. Makoto Hashimoto: Robotic cardiac surgery was not widespread until 2020. The number of procedures was not expanding like in other fields such as urology, thoracic surgery, general surgery or gynecology. I think this is because of the difficulty and complexity of cardiac surgery itself along with the lack of training facilities.
With the current generation of robots, called the Da Vinci system, the number of robotic cardiac surgeries has grown by about 15% every year since 2020. In 2024 the total number of robotic cardiac surgeries performed in the world was around 13,000, but the total number of robotic surgeries was nearly 3 million. The number of robotic cardiac surgeries still accounts for less than 0.5% of all robotic surgeries.
Regarding education, not everyone in Europe is allowed to use robots right now. But with the newest Da Vinci robot, they are planning to expand the robotic cardiac surgery field. There is a huge opportunity to work with those surgeons in Europe. Education will be a very real priority in the next five years, and we should take the initiative in that field too.
Q: How can robotic cardiac surgery contribute to better long-term patient outcomes and reduced healthcare costs for hospitals and health systems?
TN: The robot is expensive. It’s about a $2 million-piece of machinery which some hospital systems might be reluctant to purchase and embrace. But the data seems to suggest that the investment will have a return on investment several times over.
One, the patient will have a faster recovery and spend less time in the hospital, and we know that time in the hospital costs a lot of money.
There are also things that add to the cost of a hospital stay, one is blood utilization. Using blood is expensive, but with a robotic approach compared to a sternotomy approach, you use less blood because it’s a smaller incision. There is also less ventilation time and less ICU time because you’re in the ICU for a shorter period.
We know that by having the robot and establishing a high-volume center, the program will grow and bring in patients from different areas. Then, probably most importantly, we know that in experienced hands, by doing it minimally invasively with a robotic approach, it’s just better patient care.
Q: How do you see robotic cardiac surgery evolving over the next five to ten years?
MH: The Da Vinci 5, the newest robot, has not yet been approved by the FDA for cardiac surgery, though I think within a year it will be.
I’m particularly excited about an instrument called the endo-stabilizer, which can be used for TCAB, totally endoscopic coronary artery bypass grafting. It will enable the most minimally invasive coronary artery bypass surgery.
The next five years will be a major transition period for robotic cardiac surgery, more hospitals will start robotic programs and the number of cases will increase.
For the next 10 years, I think telesurgery will probably become more prominent. I’m not sure how it will be made possible, but I know telesurgery is something all surgeons are interested in.