The role of robotics in cardiac surgery: a systematic review

Doulamis, Ilias P.; Spartalis, Eleftherios; Machairas, Nikolaos; Schizas, Dimitrios; Patsouras, Dimitrios; Spartalis, Μichael; Tsilimigras, Diamantis I.; Moris, Demetrios; Iliopoulos, Dimitrios; Tzani, Aspasia; Dimitroulis, Dimitrios; Nikiteas, Nikolaos

doi:10.1007/s11701-018-0875-5

Cited by 29 publications

(20 citation statements)

References 38 publications

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“…5,6 The efficacy and safety of robotic cardiac surgery have been confirmed and described in many studies, and the procedure has a mean 30-days mortality of 0.7% (0%-0.8%). 7 In recent years, the use of robotic cardiac surgery has significantly increased. Yanagawa et al reported in 2015 that robotic cardiac surgery for all cardiac operations increased 600% in the United States from 2008 (0.06%) to 2011 (0.4%).…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

Liu

Kong

et al. 2021

Robotics Computer Surgery

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Background: This paper describes a case of a patient with situs inversus totalis (SIT) and dextrocardia in which robotic atrial septal defect (ASD) repair was successfully performed in a beating heart. Methods and Results:A 45-year-old female patient who had SIT and dextrocardia was diagnosed with secundum ASD 5 years ago. Because of progressive dyspnoea, fatigue, and obvious cough, she came to our hospital for surgical treatment. Transthoracic echocardiography showed the defect located in the middle and lower segments of the atrial septum with a maximum diameter of 27 mm, with a left-to-right shunt. Transcatheter ASD closure could not be performed because there was not enough tissue surrounding the defect. After communicating with the patient, we performed robotic ASD repair in a beating heart using the da Vinci surgical system. The operation was successful, and the patient recovered quickly. Conclusion:As a minimally invasive approach, robotic cardiac surgery has many advantages and is feasible and safe in suitable patients.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

Liu

Kong

et al. 2021

Robotics Computer Surgery

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“…Previous reports have demonstrated that RA-MIDCAB is a safe and efficacious alternative to traditional CABG, providing favorable short-term outcomes and longterm graft patency (16,17). Additional advantages of the technique include reduced need for blood transfusion, shorter hospital stay, and improved quality of life (18).…”

Section: Ra-midcabmentioning

confidence: 99%

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

Eynde¹,

Bentein²,

Decaluwé³

et al. 2021

J Thorac Dis

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Learning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB). Methods:A retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time.Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG). Results: Demographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety. Conclusions:These results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG.Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.

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“…Conventional heart surgery requires a large incision, a long hospital stay, and a prolonged recovery time [1]. Minimally invasive cardiac surgery has been successful in reducing surgical trauma and facilitating faster recovery [1,2].…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Repair of Atrial Septal Defect: A Comparison of Beating and Non-Beating Heart Surgery

et al. 2022

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Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating-and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

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The role of robotics in cardiac surgery: a systematic review

Cited by 29 publications

References 38 publications

Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

Robot-Assisted Repair of Atrial Septal Defect: A Comparison of Beating and Non-Beating Heart Surgery

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