Totally endoscopic robotic-guided pulmonary veins ablation: an alternative method for the treatment of atrial fibrillation☆

Abstract

In patients affected by isolated atrial fibrillation, epicardial pulmonary veins ablation can be performed with minimally invasive robotic-guided cardiac surgery techniques. This approach might become a feasible alternative to percutaneous transcatheter procedures. In this case report, we present a totally endoscopic robotic-guided pulmonary veins microwave ablation, on beating heart. A 64-year old male patient affected by paroxysmal atrial fibrillation was scheduled for an epicardial ablation procedure. Through three 1 cm-length port accesses, the "da Vinci" robotic system's camera and arms were introduced in the patient's chest. The pericardial reflections along the superior and inferior vena cava, as well as the transverse sinus, were dissected. Through an additional 0.5 cm-length port, a guidewire was advanced gradually across the transverse sinus, the diaphragmatic surface of the heart and the oblique sinus, finally surfacing outside the thoracic wall through the same port. Once tied to the microwave probe, the guidewire was pulled out carrying the probe inside the chest up to encircle the pulmonary veins. Once in place, a box lesion of the pulmonary veins was produced by microwave. At the 3-month follow up the patient is in sinus rhythm and so far did not longer experienced paroxysmal arrhythmic episodes.

The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation

“…The same kind of manipulation was previously performed by thoracoscopy [23]. The less invasive Maze procedure could be performed by a rigid pericardial endoscope.…”

The role of robotic technology in cardiac surgery

“…Atrial fibrillation ablation, patent ductus arteriosis closure, and atrial septal defect closure have all been performed via surgical robot. [16][17][18] discussion Current evidence shows the outcomes of robotic surgeries appear to be at least equivalent to outcomes of traditional surgeries. 4 This raises questions as to why robotic cardiac surgery has not been more widely adopted, especially when compared to the adoption of this technology in other surgical specialties.…”

The year in clinical electrophysiology

“…This is largely performed in patients requiring concomitant cardiac surgery (51). The newer techniques involve microwave application (52), and use of cryoablation (53,54), as well as endoscopic robotic-guided ablation procedures (55).…”