“Temporary cardiac arrest in patient under robotically assisted total thyroidectomy causing carotid sinus hypersensitivity.”
Chung, H. S., C. M. Park, et al. (2010).
Korean Journal of Anesthesiology 59(SUPPL.).
Carotid sinus hypersensitivity (CSH) is an exaggerated response to carotid sinus baroreceptor stimulation. Bradycardia, hypotension, and syncope are common manifestations of CSH. A 31-year-old female patient was scheduled for a robotically assisted endoscopic total thyroidectomy. No problems occurred during anesthetic induction. Sudden cardiac arrest occurred near dissection of the diseased thyroid. However, while atropine was administered, the patient soon recovered to normal sinus rhythm. Subsequent bradycardia or hypotension was not followed until the end of surgery. Copyright © 2010 Korean Society of Anesthesiologists.
“Computer aided minimally invasive cardiac procedures.”
Li, M., D. Mazilu, et al. (2010).
Minerva Chirurgica 65(4): 439-450.
Minimally invasive cardiac procedures have been investigated to reduce the risks associated with open heart surgery. With the assistance of improvements in engineering technologies such as medical imaging, surgical navigation, and robotic devices, more cardiac surgeries can be performed in a minimally invasive fashion. We have surveyed these state-of-the-art engineering technologies and the minimally invasive cardiac procedures that are benefited from these technologies.
“Robot-assisted aortic valve replacement using a novel sutureless bovine pericardial prosthesis: Proof of concept as an alternative to percutaneous implantation.”
Suri, R. M., H. M. Burkhart, et al. (2010).
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(6): 419-423.
Objective: Percutaneous aortic valve implantation within native valve calcium has progressed to clinical use despite the absence of data proving equivalence to complete surgical excision and prosthetic valve replacement. A novel self-expanding sutureless bovine pericardial prosthesis (Sorin Perceval) derived from a proven stented valve has been successfully used in humans recently through an open transaortic approach. We sought to develop a minimally invasive technique for native aortic valve excision and sutureless prosthetic aortic valve replacement using robot assistance. Methods: The da Vinci S-HD system was used to open and suspend the pericardium anterior to the phrenic nerve in cadavers. A transthoracic cross-clamp was placed across the midascending aorta, following which a transverse aortotomy was made. The native aortic valve cusps were excised, and annular calcium was removed with robotic instruments. After placement of three guide sutures, the Perceval self-expanding pericardial prosthesis mounted on a flexible delivery system was inserted through a working port and lowered into the aortic annulus. Results: Successful implantation of all valves was possible using a 3-cm right second intercostal space working port, along with two additional 1-cm instrument ports. A standard transverse aortotomy was sufficient for examination/debridement of the native aortic valve cusps, sizing of the annulus, and deployment of the nitinol-stented, bovine pericardial prosthesis. Delivery, seating, and stability of the device were easily confirmed above and below the aortic valve annulus using the robotic camera. Conclusions: Complete excision of diseased native aortic valve cusps with robot assistance facilitates accurate and reproducible aortic valve replacement using a novel self-expanding sutureless version of a proven bovine pericardial prosthesis. This approach is comparable to the current surgical gold standard and is ready for clinical use as an alternative to percutaneous aortic valve implantation. Copyright © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.