In April 2026, cardiothoracic surgeon Professor Tristan Yan performed the Southern Hemisphere's first heart surgery using the da Vinci 5, the latest generation of robotic surgical system, at Sydney Adventist Hospital (the San). The milestone reflects a broader change in cardiac care: for a growing number of patients, operations that once required opening the chest can now be performed through a few small incisions between the ribs.
Robotic-assisted heart surgery has been performed in Australia for more than two decades, yet it remains unfamiliar to many patients. Understanding how it works and who is suited to it can help patients and families weigh their options when heart surgery is recommended.
How robotic heart surgery works
Conventional open-heart surgery is usually performed through a sternotomy, in which the surgeon makes an incision down the centre of the chest and divides the breastbone to reach the heart. Robotic-assisted surgery utilises several small incisions between the ribs instead, through which a camera and slender surgical instruments are passed.
The surgeon operates from a console in the same operating theatre, viewing a magnified, three-dimensional image of the inside of the chest. The surgeon's hand movements are translated into precise movements of the instruments, which have wrist-like joints able to bend and rotate within the confined space around the heart. The robotic arms cannot move on their own; the surgeon controls every action, supported by a surgical team at the patient's side. Professor Yan, who leads robotic and minimally invasive cardiothoracic surgery at the San, has noted that this precision and responsiveness is particularly valuable in heart surgery, where accuracy is essential.
Conditions it can treat
Mitral valve repair is among the most common robotic heart operations. The mitral valve controls blood flow between the two chambers on the left side of the heart, and a leaking valve forces the heart to work harder. Robotic techniques are also used for some valve replacements, tricuspid valve repair, closing holes in the wall between the heart's upper chambers (atrial septal defects), removing certain cardiac tumours and septal myectomy, an operation that removes thickened heart muscle obstructing blood flow.
Benefits and trade-offs
Because the breastbone is left intact, patients typically experience less pain, less blood loss, a lower risk of wound infection and smaller scars. Typical hospital stays last three to four days, with most patients resuming normal activities within two to four weeks, although recovery varies from person to person.
Robotic cardiac surgery also requires specialised equipment and an experienced team, so it is offered at a limited number of hospitals with developed expertise.
Who is suited to robotic surgery
Robotic surgery is not suitable for every patient or every heart condition. Before surgery, patients undergo a detailed assessment that may include an echocardiogram (an ultrasound of the heart), a CT scan, a chest X-ray and cardiac catheterisation, which uses a thin tube and dye to examine the heart's arteries and chambers. The results, together with the patient's age, the severity of their heart disease and any other medical conditions, help the surgical team determine whether a robotic, minimally invasive or conventional approach is most appropriate.
What the newest systems offer
The da Vinci system has been used in heart surgery since the early 2000s; the da Vinci 5 is its fifth generation, cleared for use in the United States in 2024. The da Vinci 5 builds on earlier systems in several ways. According to its manufacturer, Intuitive, it offers force feedback, allowing the surgeon to sense the pressure applied to tissue, and up to 10,000 times the computing power of the previous generation. The system also supports telepresence, allowing specialists to observe procedures remotely in real time. The San has highlighted the potential for this technology to support surgical training and improve access to specialist care for regional and remote communities, although these applications are still developing.
Robotic heart surgery will not replace conventional operations, which remain the best option for many patients. For those who are suitable candidates, however, it offers a well-established, less invasive path through heart surgery, and continuing advances in the technology may extend that option to more Australians in the years ahead. Patients considering heart surgery can discuss with their cardiologist or cardiac surgeon whether a robotic approach may be appropriate for them.
References
Australian Private Hospitals Association. San’s robot firsts open up regional care options. apha.org.au
Cleveland Clinic. Robotic heart surgery. my.clevelandclinic.org
Intuitive Surgical. Intuitive announces FDA clearance of fifth-generation robotic system, da Vinci 5. investor.intuitivesurgical.com
Intuitive Surgical. Intuitive Surgical’s da Vinci Surgical System receives first FDA cardiac clearance for mitral valve repair surgery. isrg.intuitive.com
Sydney Adventist Hospital. Southern Hemisphere first robotic surgery completed at the San. sah.org.au
Professor Tristan Yan is a Clinical Collaborator with the TAIK Health Community.
Head of Cardiothoracic Surgery at Royal Prince Alfred Hospital
Director of Robotic and Minimally Invasive Cardiothoracic Surgery at the Sydney Adventist Hospital
