Totally Endoscopic Atrial Septal Defect Repair with Robotic
(#2001-73777 ... March 10, 2002)
Michael Argenziano, MD,1 Mehmet C. Oz, MD,1 Joseph J. DeRose Jr., MD,1 Robert C. Ashton Jr., MD,1
James Beck, CCP,1 Flora Wang, RN,1 W. Randolph Chitwood, MD,2 L. Wiley Nifong, MD,2
Jaina Dimitui, RN,1 Eric A. Rose, MD,1 Craig R. Smith Jr., MD1
1Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY
2Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, NC
Background: The development of minimally invasive cardiac
surgery has been characterized by the performance of
increasingly complex operations through progressively smaller
incisions. Computer (robotic) enhancement has emerged as a
potential facilitator of these procedures, initially by providing
enhanced endoscopic camera control and, more recently, by
allowing the manipulation of surgical instruments through
limited thoracic incisions. This report describes the next step
in this progression, namely the performance of an atrial septal
defect (ASD) repair entirely through thoracoscopic port incisions.
This represents the first U.S. application of robotic
technology for totally endoscopic open-heart surgery.
Materials and Methods: A 33-year-old woman with a
secundum atrial septal defect underwent totally endoscopic
repair through four port incisions by means of the Da Vinci™
(Intuitive Surgical, Mountain View, CA) robotic surgical system.
Cardiopulmonary bypass was achieved peripherally
(femoral Estech endoaortic balloon cannula; femoral and right
internal jugular venous Bio-medicus cannulae). The myocardium
was protected with antegrade cold blood cardioplegia
delivered through the distal port of the arterial cannula. After
port insertion, the entire operation, including pericardiotomy,
bicaval occlusion, atriotomy, atrial septopexy, and atrial closure,
was performed by computer-aided control of a camera and two
instrument arms manipulated by a surgeon seated 15 feet away.
The fourth port was used for suction and suture passage by the
patient-side assistant. The aortic cross-clamp time was 43 minutes,
and the postoperative transesophageal echocardiogram
demonstrated normal ventricular function and the absence of
interatrial shunting. The patient was extubated on the night of
surgery, was ambulatory within 15 hours, and was discharged
on the morning of postoperative day 3, 63 hours after the procedure.
At 30-day follow-up, the patient was well and without
complaints, and transthoracic echocardiogram confirmed the
continued absence of interatrial shunting.
Conclusions: Computer-aided robotic surgical technology
can be used to perform open-heart procedures with a
totally endoscopic approach. The benefits of this approach
may include decreased perioperative pain, decreased recovery
times, and improved cosmesis and patient acceptance. Clinical
trials currently in progress will demonstrate whether this
technology will be of reproducible value in the management
of patients with intracardiac disease on a larger scale.
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