Robotic Cardiac Surgery: The Future Gold Standard or An Unnecessary Extravagance?

Harky, Amer; Hussain, Syed Mohammad Asim

doi:10.21470/1678-9741-2019-0194

Cited by 8 publications

(4 citation statements)

References 10 publications

(13 reference statements)

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“…Furthermore, compared with CCABG and MIDCAB, R‐CABG has many advantages such as tiny incision, faster recovery and good cosmetic effect, which should be considered as the preferred choice for the revascularization strategy of iLAD patients 25 . In the future, with the continuous development of engineering technology, robotic heart surgery will become a medical routine to serve more clinical patients 26,27 …”

Section: Discussionmentioning

confidence: 99%

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Zhang

Xiao

et al. 2021

J Card Surg

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Objective To compare the midterm outcomes of patients with isolated left anterior descending disease (iLAD) who underwent robotically assisted coronary artery bypass graft (R‐CABG) and percutaneous coronary intervention (PCI) with drug eluting stents (DES). Method Clinic data was collected in 223 patients who underwent R‐CABG in our hospital between July, 2007 to November, 2014. Cardiology Database System of our hospital was used to identify 4047 patients who underwent PCI with DES for LAD lesion between April, 2011 to November, 2014. Total 496 patients received DES and 108 patients underwent R‐CABG after screening. Patients were propensity matched into 108 R‐CABG and DES pairs according to vital statistic. Mortality, myocardial infarction (MI), stroke, repeat target lesion revascularization (r‐TLR), main adverse cardiac and cerebral events (MACCE), and angina relief were compared across pairs. Result Kaplan–Meier estimates for R‐CABG and DES had no significant difference in mortality (p = 1.00), MI (p = .32), Stroke (p = .80), and MACCE (p = .47), but the rate of r‐TLR (p = .03) were lower in R‐CABG group. Patients who underwent R‐CABG had better angina relief (p = .02), lower rate of arrhythmia (p < .001), and recurrent angina (p = .02) after operation compared patients received DES. Conclusion R‐CABG offers lower r‐TLR rate and better angina relief compared with DES for revascularization in patients with isolated proximal LAD stenosis and there was no difference in mortality, MI, stroke, and MACCE between them.

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Section: Discussionmentioning

confidence: 99%

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Zhang

Xiao

et al. 2021

J Card Surg

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“…43 However, currently this has not been tested in CABG and in future could be an avenue to explore. 44,45,46…”

Section: Future Directionmentioning

confidence: 99%

“…The integration of novel force sensors on the trocars should enable surgeons to anticipate and feel the suturing forces and therefore minimize unnecessary pressure on delicate tissues or vessels 43 . However, currently this has not been tested in CABG and in future could be an avenue to explore 44 , 45 , 46 …”

Section: Future Directionmentioning

confidence: 99%

Robotic coronary artery surgery: Outcomes and pitfalls

Ravikumar

George

Shirke

et al. 2020

Journal of Cardiac Surgery

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Objective: Coronary artery bypass grafting is one of the most commonly performed surgical procedures in cardiovascular surgery with a steadily evolving minimally invasive approach. Methods: Conventional coronary artery bypass grafting (CABG) is performed traditionally via midline sternotomy. Exciting advancements in technology and engineering over the last two decades have resulted in the transition from conventional to minimally invasive CABG including robotically assisted surgery. Results: The minimally invasive techniques are continuously striving to promote coronary revascularization into the arena of minimally invasive surgery. Examination of 10 previously completed studies with relevant follow-up periods enables an insightful vision into the outcomes and pitfalls surrounding robot-assisted CABG (RACAB) as explored in this review. Studies indicate that RACAB is associated with decreased postoperative complications such as major adverse cardiac or cerebrovascular events without compromise in survival rates. Despite this, certain drawbacks such as incurring costs and technical complexity of the procedure cannot be dismissed. Conclusion: There exist patient-related benefits from minimally invasive techniques such as decreased certain postoperative complications. Furthermore, with experience and a specialized stepwise program, it is possible to perform the entire procedure from the console. However, certain pitfalls involving increased expenses, steep learning curve and the lack of proper haptic feedback currently withhold the worldwide expansion of RACAB and limit it to specialized institutions only.

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“…Given the complexity associated with robotics, careful patient selection is important and requires a high degree of operator experience for a successful outcome. 19 However, the initial capital investment along with the maintenance cost has limited its uptake 20 and research is sparse for double valve pathology, with a greater focus on single valve only. 21,22 Ranganath et al 23 conducted mitral valve (MV) surgery with the assistance of robotics, noting several cases requiring concomitant tricuspid repair with overall positive outcomes.…”

Section: History Of Minimally Invasive Double Valve Surgerymentioning

confidence: 99%

Outcomes in minimally invasive double valve surgery

et al. 2020

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Objective: To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS). Methods: A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript. Results: Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates. Conclusion: Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid-and long-term morbidity and mortality rates associated with both techniques. K E Y W O R D S cardiac surgery, double valve, minimal access, minimal invasive 1 | INTRODUCTION Minimally invasive surgery (MIS) is a rapidly evolving technique for valvular pathologies, which has seen an increase in adoption over the last 24 years due to its popularization by Navia and Crosgrove. 1 The conventional median sternotomy (MS) has been the standard approach for decades, due to good exposure of the surgical field and more surgical experience with the technique, but MIS has gained more acceptance. The uptake has been slow in the past, possibly due to the learning curve reported and previous lack of established training programmes, but the outcomes reported have been at least as good, if not better, than MS. 2 In single valve surgery, MIS has been shown to have cosmetic, respiratory and blood product use advantages over MS, amongst many other benefits. 3,4 However, longer operation times have been reported for MIS. 5 In the USA, multiple valve surgery accounts for 3%-25% of all valve surgeries annually, 6 yet few studies have focussed on a minimally invasive approach for double valve surgery, with even less directly comparing MIS to MS. We reviewed the current literature to evaluate the outcomes of a minimally invasive approach to double valve surgery.

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Robotic Cardiac Surgery: The Future Gold Standard or An Unnecessary Extravagance?

Cited by 8 publications

References 10 publications

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Robotic coronary artery surgery: Outcomes and pitfalls

Outcomes in minimally invasive double valve surgery

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