Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation

AbstractObjectiveStandard surgical closure of an atrial septal defect via sternotomy is a safe and effective procedure with low morbidity and mortality. Considering that young female patients are frequently operated on for atrial septal defects, a minimally invasive procedure avoiding sternotomy is convincingly desirable and led to the approach through a right anterolateral minithoracotomy. The recent clinical introduction of robotically assisted surgery further reduced skin incisions and enabled totally endoscopic procedures through ports. This article reports on a first series of atrial septal defect closures of which the first case was operated on August 24, 1999, in a totally endoscopic closed chest technique using a computer-enhanced telemanipulation system.MethodsWe performed totally endoscopic atrial septal repair using the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif) in 10 consecutive adult patients. Median age was 45.5 ± 10.0 years, and preoperative New York Heart Association functional class was 1.8 ± 0.1. Left ventricular ejection fraction was normal in all patients and mean pulmonary artery pressure amounted to 35 ± 7 mm Hg. Shunt volume ranged from 24% to 70%. All patients displayed a fossa ovalis type of atrial septal defect; 2 of them multiperforated.ResultsNeither intraoperative nor postoperative complications occurred. Two patients had to be converted to minithoracotomy due to endoaortic balloon clamp failure. Length of operation was 262 ± 37 minutes, and cardiopulmonary bypass time was 161 ± 26 minutes. Intraoperative transesophageal echocardiography certified complete closure of the atrial septal defect in all patients. The totally endoscopic computer-enhanced technique yielded excellent cosmetic results.ConclusionTotally endoscopic atrial septal repair is a feasible and safe procedure with good clinical results and excellent cosmetic outcomes. It may be considered as perfect adjunct to interventional treatment options. Further studies with larger cohorts and randomized trials are necessary to document potential benefits. Evolution in robotic technology and refinement of procedural flow may shorten procedural time and decrease costs

Robotic coronary artery surgery : past, present and future

Minimal invazif endoskopik giriflimlerin kalp cerrahisinde kullanımı ancak telemanipülatör sistemlerin kullanıma girmesiyle mümkün olmufltur. Bu çalıflmada total endoskopik revaskülarizasyon için kullanılan robotik destekli telemanipülasyon sistemleri gözden geçirilip, çalıflan ve duran kalpte uygulamalar derlenmifltir. Robotik cerrahi günümüzde halen geliflme aflamasındadır. Maliyetin yüksek oluflu ve sadece seçilmifl bir hasta grubunda uygulanabiliyor olması bu yeni tekni¤in en büyük sınırlayıcı faktörleridir. Ancak teknoloji üzerine çalıflmalar ve özellikle anastomoz tekniklerinin geliflmesiyle koroner revaskülarizasyon için bir alternatif olacaktır. Henüz istenen hedeflere ulaflılmamıflsa da gelecek umut vericidir.Minimally invasive endoscopic procedures in cardiac surgery have only become possible since the introduction of telemanipulator systems. In this study we review robotic assisted telemanipulation systems and procedures on beating and arrested heart for total endoscopic revascularization. Robotic surgery is still under development. The most important factors limiting this new technique are high costs and the fact that only selected patients are able to be operated on. But studies on technology especially to improve anastomotic techniques are going on to produce an alternative for coronary revascularisation. We didn’t yet hit all goals but the future seems promising