Robotic assisted minimally invasive surgery for atrial septal defect correction

Abstract

Descriptors: Heart septal defects, atrial. Surgical procedures, minimally invasive/methods. Robotics.Descritores: Comunicação interatrial. Procedimentos cirúrgicos minimamente invasivos/métodos. Robótica. CHARACTERIZATION OF PATIENTThe characteristics of the patient are: female, 24 years old, 55 kg. She came to our department with complaints of fatigue and palpitations. She denied any associated disease or medication use. On physical examination, the patient was eutrophic, eupneic at rest, without edema. No alterations of pulmonary auscultation and cardiac auscultation revealed a sinus rhythm, with pulmonary systolic murmur with fixed splitting of 2nd heart sound. Resting blood pressure (BP) was: 100/70 millimeters of mercury (mmHg).The chest radiograph showed normal heart size and increased pulmonary vasculature. Echocardiography revealed a normal left atrial dimension (LA) of 2.9 centimeters (cm) and left ventricular (LV) diameter within normality (LV Systolic Diameter: 2.5 cm -LV Diastolic Diameter: 4.2 cm ) and normal myocardial thickness. The other cavities were also normal. The presence of interatrial comunication (IAC) secundum ostium type showed the Doppler that the shunt with unidirectional flow of LA to the right. The ejection fraction was estimated at 72% (Simpson). The pulmonary artery pressure was estimated at 40 mmHg and increased pulmonary blood flow: 1.5 cm /second (cm/s).The electrocardiogram showed sinus rhythm with right bundle branch block.After discussing the clinical case, the surgery to repair the IAC was indicated. In a conversation with the patient after the explanation of the techniques type available to the IAC and also signed informed consent, she chose the robot-assisted minimally invasive approach [1].Surgical correction consisted of atrial septal defect with a bovine pericardial patch. The duration of extracorporeal circulation (EC) was 63 minutes (min) and aortic clamping, 38 min.The patient was extubated in the operating room; the postoperative bleeding was 340 milliliters (ml), length of ICU stay of 14 hours, had a great postoperative evolution and was discharged on the 2nd day after surgery. On the discharge day, the echocardiogram showed a normal ventricular function and an intact atrial septum, with well positioned patch without residual shunt.

Robotic Surgery: Bioethical Aspects

“…Then came the Robodoc - saw used in hip prosthesis replacement operation - ACRobot - used in knee operations - and RX-130 - used in operations in temporal region 14 . Currently, robots assist minimally invasive operations for interatrial communication correction 21 .…”

“…There are also robotic models such as the da Vinci, the Intuitive Surgical Inc., Sunnyvale, California, USA, and the ZEUS Robotic Surgical System, built by the company Computer Motion Inc., Goleta, California, USA with widespread use in laparoscopic, thoracoscopic and cervicoscopic operations 20 , 21 , 35 . Indeed, the robots - today - have contributed to greater precision in surgical procedures, collaborating, for example, to expand the three-dimensional field of view in interventions that require greater surgeon skill, as noted in colorectal videosurgeries and the arterial anastomosis in heart 3 , 20 .…”

Cirurgia robótica em Cardiologia: um procedimento seguro e efetivo

“…The robotic technique described by Poffo et al ( 7 ) was used in the cases of surgical correction of atrial septal defect (ASD). The approach is very similar to that used in the robotic-assisted mitral valve repair ( 8 ) .…”

Robotic cardiac surgery in Brazil

“…In ASD repair, the right atrial chamber was accessed after isolation of the superior and inferior venae cavae. The introduction of the micro camera into the right atrium enabled the ASD to be visualized and corrected using a bovine pericardial patch (12). In all seven cases of this series, ASDs were classified as ostium secundum.…”