Totally Endoscopic Atrial Septal Defect Repair With Robotic Assistance

Abstract

Background-Computer (robotic) enhancement had emerged as a facilitator of minimally invasive cardiac surgery, and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the next step in this progression-the first U.S. application of robotic technology for totally endoscopic open heart surgery. Methods and Results-Seventeen patients underwent repair of a secundum-type atrial septal defect (nϭ12) or patent foramen ovale (nϭ5) by a totally endoscopic approach, utilizing the Da Vinci robotic system. Cardiopulmonary bypass (CPB) was achieved peripherally. Cardioplegia was administered via the distal port of the arterial cannula after endo-balloon inflation. Via three port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, atrial septopexy, and atrial closure were performed by a surgeon seated at a computer console. A fourth 15-mm port was utilized for suction and suture passage by a patient-side assistant. The mean age of the patients was 47 years (range, 22 to 68). Aortic crossclamp time was 32 minutes (median), and CPB time was 122 minutes. In 16 patients, transesophageal echocardiography after 30 days confirmed successful repair. In one patient, a recurrent shunt was identified and repaired on postoperative day 5. Median length of stay (LOS) in the intensive care unit was 20 hours, and median hospital length of stay was 4 days. Conclusions-Robotic

Padronização da técnica para cirurgia cardíaca videoassistida: experiência inicial

“…The first was a mitral valve reoperation which FORTUNATO JUNIOR, JA ET AL -Standardization of video-assisted cardiac surgery technique: initial experience allowed a recommissurotomy by totally endoscopic approaches (Figure 4). Similar report was presented in surgery for an atrial septal defect correction with minimally invasive procedures; the procedure were achieved by totally endoscopic approaches [23,24].…”

Cirurgia cardíaca videoassistida

“…In the group of congenital heart disease, those times were even lower, with 1.3 ± 0.5 days in ICU and 2.6 ± 0.8 days of postoperative hospitalization, numbers that demonstrate the expected result for this technique. Argenziano et al [41] reported 20 hours of admission and 4 days of hospitalization, Modi et al [40], six days of hospitalization, and Poffo et al [39], 6.5 days of hospitalization.…”

Robotic assisted minimally invasive surgery for atrial septal defect correction

“…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].…”