A comparison of robotically-assisted endoscopic versus sternotomy approach for myxoma excision: A single-center experience

Abstract

Background: In this study, we present our single-center experience in robotically-assisted endoscopic surgery versus conventional median sternotomy approach in patients undergoing cardiac myxoma excision. Methods: Between January 2011 and September 2019, a total of 46 patients (24 males, 22 females; mean age 54.1±12.5 years; range, 25 to 79 years) who had a confirmed diagnosis of isolated cardiac myxoma were included in the study. The patients were divided into two groups as those undergoing robotic-assisted surgery (n=16) and those undergoing conventional median sternotomy (n=30). Clinical characteristics, operative, and postoperative outcomes were compared. Robotic approach to right or left-sided tumors and postoperative pain scores were also analyzed. Results: There was no mortality or major complication. No conversion to sternotomy was needed in robotic procedures. The mean cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the median sternotomy group (p=0.001 for both). The mean ventilation time and the length of hospital stay were significantly shorter in robotic surgery than sternotomy group (p=0.043 and p=0.048, respectively). The mean amount of postoperative blood loss and transfusion rate were significantly lower in robotic surgery patients (p=0.001 and p=0.022, respectively). The mean postoperative pain scores were significantly lower in patients undergoing robotic surgery (p=0.022). Conclusion: Robotic-assisted endoscopic surgery can be performed safely and effectively for cardiac myxoma excision with shorter hospital stay, less pain, and less amount of blood product use, as well as more favorable cosmetic results compared to conventional median sternotomy.

Routine endoscopic robotic cardiac tumor resection using an 8‐mm working port and percutaneous cannulation

“…Robotic myxoma removal is also associated with increased operative time because it requires the surgeon to re-scrub when moving between the console and bedside to dock/undock the robot. 16 It is integral to the success of robotic myxoma and fibroelastoma removals that longer-term outcomes be studied to more comprehensively understand the risks and benefits of the approach.…”

“…Prior studies have demonstrated robotic excision of cardiac tumors as a safe and effective treatment option. [13][14][15][16][17] Typically, five ports are utilized with the da Vinci Surgical System (Intuitive Surgical), the only approved robotic system for cardiac procedures in the United States. The five incisions include: three robotic arm ports, one atrial retractor port, and one "working port.…”

Giant left atrial myxoma presenting as cerebral embolism

“…Carney Complex is an autosomal dominant syndrome and may be associated with multiple neoplasms (heart, skin, breast), endocrinopathy, testicular tumors, and schwannoma. Although recurrence is not common in sporadic myxoma, inadequate resection, intraoperative implantation, and embolization of tumor fragments may cause recurrence (16,17).…”

Technical aspects of robotically assisted left atrial myxoma resection

“…Given the acute risk of thromboembolic and obstructive events, urgent resection is generally recommended. While the historical approach is via median sternotomy, there are fewer than 100 cases reported in the literature of successful robotic-assisted myxoma excisions since the first in 2005 ( 1 - 4 ). Operative suitability is restricted to patients who can tolerate single-lung ventilation before initiating cardiopulmonary bypass.…”

“…The multi-wristed robotic instruments allow easier excision of the tumor than with long shafted minimally invasive cardiac surgery (MICS) instrumentation. Patient outcome data demonstrate shorter ICU and hospital stay ( 2 - 4 ), superior cosmesis, and improved subjective post-operative quality of life ( 3 ) compared to sternotomy.…”