Tiny Tools. Tiny Scars. Big Benefits for the Heart



Dr. Richard Rembecki doesn’t carry around the signature mark of someone who has had cardiac bypass surgery. The large, long scar that would sit right in the middle of the chest is nowhere to be found.

Instead the pediatric pulmonologist at Sanford Children’s Specialty Clinic bears a few tiny scars from his surgery, which was performed in July at Sanford Heart Hospital.

Why such small scars? He was the first patient to have robotic-assisted bypass surgery and couldn’t be happier with the results.

In 2010, he discovered he had complete or partial blockage in three separate areas of the heart. He had stents put in to clear two of the blockages but the third, located in his left anterior descending artery (LAD), could not be treated.

“I had 100 percent blockage in my LAD, and my cardiologist just could not get it stented, which can sometimes happen,” Dr. Rembecki says. “I was still getting… circulation flow to the area, so we were in a bit of a holding pattern.”

With medication, diet and exercise, he continued on with his career and life, which led him to Sanford in Sioux Falls. Like any new resident, he started to make the rounds and got his new family practice doctor and cardiologist selected.

During a visit with Dr. Tom Stys, cardiologist at Sanford, a routine stress test was performed. Dr. Stys was not satisfied with the results.

“He said I was too young to have this type of blood flow in my heart,” Dr. Rembecki smiled. “He wanted better.”

After two additional attempts to reach the blockage during a cardiac catheterization in March were unsuccessful, Dr. Rembecki discussed his options with Dr. Stys. He was given three options: Leave things alone for now and observe, get a second opinion, or have a bypass.

But Dr. Stys then suggested a new type of bypass, only available at Sanford – minimally invasive robotic surgery. Dr. Rembecki visited with Dr. David Maziarz, a new addition to Sanford's heart team who brough texperience in robotics and minimally invasiv approaches to cardiac surgery.

“I also did my own research and thought long and hard about this procedure,” Dr. Rembecki says. “I decided the surgery was my best option. I was tired a lot. While it could be contributed to stress, work or just getting older, I wondered if my heart was working like it should. What if a bypass could change things for me?”

Dr. Rembecki contacted Dr. Maziarz schedule the procedure

“Right now, patients with blockage in a single vessel are ideal candidates for this procedure, but in the future that could change,” Dr. Maziarz says.

The robotic-assisted procedure allowed Dr. Maziarz to work through small incisions using tiny, precision-guided instruments. During the procedure, he sat at a controlling console in the operating room, instead of standing directly beside Dr. Rembecki.

Dr. Maziarz had clear visualization through a video monitor while he controlled a set of robotic arms that replicated his hand movements. The area of Dr. Rembecki’s blockage was then bypassed, reestablishing a normal, healthy blood flow.

“This technology provides our patients with the benefits of conventional bypass surgery, plus the recovery benefits of minimally invasive procedures,” Dr. Maziarz says. “It is the best of both worlds.”

Instead of taking as much as 12 weeks to recover, this procedure cuts that time in half. Dr. Rembecki returned home after three days in the hospital and was back to work three weeks after his surgery, which is unheard of with traditional bypass surgery.

It was during his rehabilitation that Dr. Rembecki noticed just how effective the surgery had been. He began working on the treadmill and building his endurance.

“Before the surgery, I always felt I hit a wall and just couldn’t get the benefits of exercise,” he says. “I knew it was important to be active, especially with my condition, but it became more and more difficult.”

Dr. Richard Rembecki doesn’t carry around the signature mark of someone who has had cardiac bypass surgery. The large, long scar that would sit right in the middle of the chest is nowhere to be found.

Instead the pulmonologist at Sanford Children’s Specialty Clinic bears just two tiny scars from his surgery, which was performed in July at Sanford Heart Hospital.

Why such small scars? He was the first patient to have robotic-assisted bypass surgery and couldn’t be happier with the results.

In 2010, he discovered he had complete or partial blockage in three separate areas of the heart. He had stents put in to clear two of the blockages but the third, located in his left anterior descending artery (LAD), could not be treated.

“I had 100 percent blockage in my LAD, and my cardiologist just could not get it stented, which can sometimes happen,” Dr. Rembecki says. “I was still getting… circulation flow to the area, so we were in a bit of a holding pattern.”

With medication, diet and exercise, he continued on with his career and life, which led him to Sanford in Sioux Falls. Like any new resident, he started to make the rounds and got his new family practice doctor and cardiologist selected.

During a visit with Dr. Tom Stys, cardiologist at Sanford, a routine stress test was performed. Dr. Stys was not satisfied with the results.

“He said I was too young to have this type of blood flow in my heart,” Dr. Rembecki smiled. “He wanted better.”

After another attempt to reach the blockage during a cardiac catheterization in March was unsuccessful, Dr. Rembecki discussed his options with Dr. Stys. He was given three options: Leave things alone for now and observe, get a second opinion, or have a bypass.

But Dr. Stys then suggested a new type of bypass, only available at Sanford – minimally invasive robotic surgery.

“I did my own research and thought long and hard about this procedure,” Dr. Rembecki says. “I really thought the surgery was my best option. I was tired a lot. While it could be contributed to stress, work or just getting older, I wondered if my heart was working like it should. What if a bypass could change things for me?”

Dr. Rembecki was referred to Dr. David Maziarz, a new addition to Sanford’s heart team who brought experience in robotics and minimally invasive approaches to cardiac surgery.

“Right now, patients with blockage in a single vessel are ideal candidates for this procedure, but in the future that could change,” Dr. Maziarz says.

The robotic-assisted procedure allowed Dr. Maziarz to work through small incisions using tiny, precision-guided instruments. During the procedure, he sat at a controlling console in the operating room, instead of standing directly beside Dr. Rembecki.

Dr. Maziarz had clear visualization through a video monitor while he controlled a set of robotic arms that replicated his hand movements. The area of Dr. Rembecki’s blockage was then bypassed, reestablishing a normal, healthy blood flow.

“This technology provides our patients with the benefits of conventional bypass surgery, plus the recovery benefits of minimally invasive procedures,” Dr. Maziarz says. “It is the best of both worlds.”

Instead of taking as much as 12 weeks to recover, this procedure cuts that time in half. Dr. Rembecki returned home after three days in the hospital and was back to work three weeks after his surgery, which is unheard of with traditional bypass surgery.

It was during his rehabilitation that Dr. Rembecki noticed just how effective the surgery had been. He began working on the treadmill and building his endurance.

“Before the surgery, I always felt I hit a wall and just couldn’t get the benefits of exercise,” he says. “I knew it was important to be active, especially with my condition, but it became more and more difficult.”

What he was missing was the “high” people feel when exercising. After the surgery, he was able to achieve that feeling once again.

“My exercise capacity was 50 percent higher after the surgery,” he said triumphantly. “What kept me from going faster during therapy was actually my creaky knees, not my heart.”

When asked if he would recommend this procedure to others, Dr. Rembecki’s answer is a resounding ‘yes.’

“I knew I was in good hands and trusted the expertise of Dr. Maziarz and his team,” he says. “If you can choose to have just a few small incisions made, but get the same benefits of a traditional bypass, it’s a pretty simple decision.”

Call (605) 312-2100 to schedule an appointment or for more information about the minimally invasive procedures offered at Sanford Heart Hospital.

Posted Date: November 2013

Tiny Tools. Tiny Scars. Big Benefits for the Heart

Dr. Richard Rembecki was the first patient to receive a cardiac bypass using the latest minimally invasive robotic surgery. The procedure is not available anywhere else in the region, and helped the pulmonologist at Sanford Children’s get back to life and work quicker than with traditional bypass surgery.