Modern heart surgery no longer means a large chest opening and months of recovery. Discover how robotic and keyhole cardiac techniques are changing outcomes for patients across Rajasthan.
By the Apex Hospitals Editorial Team · Published July 2025
Traditional open-heart surgery requires a full median sternotomy — a vertical incision through the breastbone — to give the surgeon direct access to the heart. While this approach remains the gold standard for many complex procedures, it carries a significant recovery burden: hospital stays of one to two weeks, sternal healing over six to eight weeks, and restrictions on driving and lifting for months.
Minimally invasive cardiac surgery (MICS) achieves the same surgical goals through much smaller incisions — typically 3–5 cm — between the ribs, or through a series of port-sized openings when robotic assistance is used. The heart-lung bypass machine is still employed in most cases, but the trauma to the chest wall is dramatically reduced.
According to the American Heart Association, minimally invasive approaches are now established for a wide range of procedures including mitral valve repair and replacement, atrial septal defect closure, tricuspid valve surgery, and selected coronary artery bypass cases. Patient selection and surgical expertise remain the two most critical factors in achieving safe outcomes.
Robotic cardiac surgery takes minimally invasive technique a step further. The surgeon operates from a console, controlling robotic arms that hold miniaturised instruments inserted through small ports in the chest wall. A high-definition 3D camera provides magnified views of the operative field that exceed what the naked eye can see through a conventional incision.
Key advantages of the robotic platform include:
Tremor filtration: The system scales and filters the surgeon's hand movements, eliminating physiological tremor and enabling suturing in confined spaces with millimetre precision.
Wristed instruments: Robotic instruments articulate with seven degrees of freedom — far beyond the range of the human wrist — allowing complex manoeuvres inside the chest.
Enhanced visualisation: 10× magnified 3D optics reveal tissue planes and suture lines with exceptional clarity.
Reduced blood loss: Smaller incisions and precise dissection translate to less intraoperative bleeding and a lower transfusion rate.
A 2022 systematic review published on PubMed (NIH) found that robotic mitral valve repair was associated with significantly shorter hospital stays, lower rates of wound infection, and equivalent long-term valve durability compared with conventional open surgery, reinforcing its role as a viable first-line approach in experienced centres.
Not every cardiac surgery is a candidate for a minimally invasive approach, but the list of suitable procedures has expanded considerably over the past decade:
Mitral valve repair and replacement — the most common robotic cardiac procedure worldwide; repair rates above 95% are achievable in experienced hands.
Tricuspid valve repair — often performed concurrently with mitral surgery through the same minimally invasive access.
Atrial septal defect (ASD) closure — robotic closure avoids a sternotomy scar entirely, particularly valued by younger patients.
Coronary artery bypass grafting (CABG) — totally endoscopic or hybrid approaches combine robotic grafting with catheter-based stenting for multi-vessel disease.
Atrial fibrillation ablation (surgical Maze) — minimally invasive Maze procedures can be performed through thoracoscopic ports.
Cardiac tumour resection — myxomas and other benign tumours are well-suited to robotic removal.
Patients with prior chest surgery, severe lung disease, or highly complex multi-valve pathology may still require conventional open surgery. The cardiothoracic surgery team at Apex Hospitals evaluates each case individually to recommend the safest, most effective approach.
| Factor | Open Surgery | Mini-Invasive (MICS) | Robotic |
|---|---|---|---|
| Incision size | 20–25 cm sternotomy | 3–6 cm between ribs | 4 × 1 cm ports |
| Hospital stay | 7–14 days | 4–7 days | 3–5 days |
| Return to normal activity | 6–8 weeks | 3–4 weeks | 2–3 weeks |
| Blood transfusion risk | Higher | Moderate | Lower |
| Wound infection risk | Higher | Lower | Lowest |
| Surgical precision | High | High | Very High |
These figures represent general clinical benchmarks; individual outcomes depend on patient health status, surgical complexity, and the experience of the operating team.
Ideal candidates for minimally invasive or robotic cardiac surgery generally share several characteristics:
Isolated mitral, tricuspid, or aortic valve disease without severe calcification
Atrial septal defects or patent foramen ovale requiring surgical closure
Atrial fibrillation amenable to surgical ablation
Benign cardiac tumours (e.g., left atrial myxoma)
Patients who are particularly concerned about cosmesis or rapid return to work
Redo valve surgery where sternotomy carries higher risk
Patients with heavily calcified aortas, severe peripheral vascular disease, or prior right-sided chest surgery may not be suitable. A thorough pre-operative assessment — including echocardiography, CT angiography, and pulmonary function testing — guides the final decision. The cardiology specialists at Apex Hospitals Jaipur work alongside the surgical team to ensure every patient receives the most appropriate recommendation.
Jaipur has emerged as a regional hub for advanced cardiac care, drawing patients not only from across Rajasthan but also from neighbouring states such as Madhya Pradesh, Haryana, and Uttar Pradesh. The city's concentration of tertiary-care hospitals, combined with improving road and air connectivity, makes it a practical destination for patients seeking procedures that were previously available only in Delhi or Mumbai.
Rajasthan's disease burden reflects national trends: cardiovascular disease is the leading cause of mortality in India, accounting for approximately 28% of all deaths, according to data published by the World Health Organization India office. Early access to advanced surgical options — rather than prolonged medical management — is increasingly recognised as critical to improving outcomes.
Apex Hospitals, established in Jaipur in 1994 and NABH accredited, has been at the forefront of this evolution. The hospital's Hybrid Cath Lab supports complex interventional and hybrid cardiac procedures, while the Cardiac ICU provides dedicated post-operative monitoring. The HOPE Tele-ICU Command Centre — featured in the Harvard Business Review — extends this expertise to 18 partner sites across Rajasthan, ensuring that patients in underserved districts can access specialist consultation without travelling to the city.
Advanced cardiac surgery is only as good as the environment supporting it. At Apex Hospitals Malviya Nagar, the cardiac surgical programme is backed by:
Hybrid Cath Lab: Enables combined surgical and catheter-based interventions in a single setting, reducing the need for staged procedures.
Cardiac ICU: Dedicated post-operative monitoring with round-the-clock intensivist cover.
ECMO capability (VV and VA): For patients who develop severe cardiac or respiratory failure peri-operatively, Apex's ECMO programme has achieved an 80% survival rate — among the strongest outcomes in Rajasthan. Learn more about the ECMO programme at Apex Hospitals.
Emergency OTs available 24×7: Modular operating theatres with full anaesthetic and perfusion support at any hour.
On-site CT, MRI, and emergency labs: Rapid pre- and post-operative imaging without transfer delays.
In-house physiotherapy unit: Early mobilisation protocols begin within 24 hours of surgery, a key driver of faster recovery after minimally invasive procedures.
This infrastructure is complemented by the hospital's ICU and critical care team, which manages post-cardiac surgery patients using evidence-based protocols and continuous monitoring.
The process begins with a detailed cardiac evaluation: echocardiography to assess valve function and chamber dimensions, coronary angiography if ischaemic disease is suspected, and a CT scan to map vascular anatomy relevant to cannulation. Blood tests, pulmonary function, and anaesthetic assessment complete the pre-operative picture.
The cardiothoracic surgeon, interventional cardiologist, anaesthetist, and perfusionist review findings together in a multidisciplinary meeting. The optimal surgical approach — robotic, video-assisted thoracoscopic, or conventional — is agreed upon and explained to the patient and family.
For a robotic mitral valve repair, for example, the patient is placed under general anaesthesia. Cardiopulmonary bypass is established via femoral vessels. The surgeon operates from the robotic console, repairing the valve through four small ports in the right chest. Total operative time is typically 3–4 hours.
Patients are extubated (breathing tube removed) within 4–6 hours of surgery in most minimally invasive cases. The Cardiac ICU team monitors haemodynamics, rhythm, and fluid balance overnight. Most patients step down to a regular ward within 24–48 hours.
The physiotherapy and rehabilitation team begins breathing exercises and gentle mobilisation from day one. Discharge typically occurs on day 3–5 for robotic cases. A structured cardiac rehabilitation programme follows, with outpatient reviews at two weeks, six weeks, and three months.
Apex Hospitals' investment in robotic technology extends across specialties. The hospital uses the CORI Surgical System by Smith+Nephew for imageless robotic knee replacement, and a Make-in-India Robotic Surgery System for select oncological procedures. This cross-specialty robotic infrastructure reflects the hospital's broader commitment to precision medicine — and the cardiac surgery programme benefits from the same culture of technological adoption and surgical excellence.
Patients interested in the full scope of robotic and minimally invasive procedures available at Apex can explore the robotic surgery programme for a comprehensive overview.
Fact: The surgical goals — valve repair, defect closure, bypass grafting — are identical to open surgery. The difference is the access route, not the quality or completeness of the repair. In experienced centres, robotic mitral repair rates exceed those achieved through conventional sternotomy.
Fact: The surgeon is in complete control at all times. The robotic system is a tool that translates the surgeon's movements with greater precision; it does not make independent decisions. The term "robotic" refers to the mechanical arms, not artificial intelligence directing the surgery.
Fact: Older patients and those with comorbidities such as diabetes or mild lung disease may actually benefit more from minimally invasive approaches because the reduced physiological stress of a smaller incision lowers the risk of complications like sternal wound infection, prolonged ventilation, and post-operative pneumonia.
Fact: While the upfront procedural cost may be slightly higher, shorter hospital stays, fewer complications, and faster return to work often make the total cost of care comparable or lower. Apex Hospitals is empanelled under Ayushman Bharat and major insurance and TPA schemes, making advanced cardiac surgery accessible to a broader patient population.
Yes, in experienced centres. Large multi-centre studies have demonstrated equivalent or superior safety profiles for robotic cardiac surgery compared with conventional open surgery for appropriate indications. As with all cardiac procedures, outcomes are closely tied to the volume and expertise of the surgical team.
Most patients undergoing robotic or video-assisted cardiac surgery are discharged within 3–5 days and can return to light daily activities within 2–3 weeks. Full recovery, including return to exercise and work, typically occurs within 4–6 weeks — roughly half the time required after conventional open surgery.
Robotic surgery leaves only small port-site scars (approximately 1 cm each) on the right side of the chest, which are largely hidden by the arm. There is no sternotomy scar. Many patients, particularly younger individuals and women, cite cosmesis as an important factor in choosing a minimally invasive approach.
Redo cardiac surgery through a prior sternotomy carries higher risk due to adhesions and scarring. In selected cases, a minimally invasive right thoracotomy or robotic approach can actually be safer for redo mitral or tricuspid valve surgery, avoiding the hazards of re-entering the sternum. Each case requires careful imaging and surgical planning.
Yes. Apex Hospitals is empanelled under Ayushman Bharat (PM-JAY) and is recognised by major insurance companies and TPA schemes. The hospital's patient services team can assist with pre-authorisation and cashless admission processes.
The specialist doctors at Apex Hospitals include experienced cardiothoracic surgeons and cardiologists who offer detailed consultations, including second opinions on surgical recommendations made elsewhere. Appointments can be booked online or by calling the Malviya Nagar branch directly.
The cardiothoracic surgery team at Apex Hospitals, Jaipur offers personalised consultations to help you understand whether a minimally invasive or robotic approach is right for your condition.
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