“The golden age of minimally invasive cardiothoracic surgery: Current and future perspectives.”
Iribarne, A., R. Easterwood, et al. (2011).
Future Cardiology 7(3): 333-346.
Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments and robotic technology, cardiac surgery was provided with the necessary tools to progress to less invasive approaches. However, much of the early literature on MICS focused on technical reports or small case series. The safety and feasibility of MICS have been demonstrated, yet questions remain regarding the relative efficacy of MICS over traditional sternotomy approaches. Recently, there has been a growth in the body of published literature on MICS long-term outcomes, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability. In this article, we examine the technological advancements that have made MICS possible and provide an update on the major areas of cardiac surgery where MICS has demonstrated the most growth, with consideration of current and future directions. © 2011 Future Medicine Ltd.
“Totally thoracoscopic repair of atrial septal defect without robotic assistance: A single-center experience.”
Ma, Z. S., M. F. Dong, et al. (2011).
Journal of Thoracic and Cardiovascular Surgery 141(6): 1380-1383.
Objective: The recent advent of robotically assisted surgery has enabled totally endoscopic repair of atrial septal defects and patent foramen ovale. This study investigates the feasibility and safety of totally endoscopic repair of an atrial septal defect through small incisions on the chest without robotic assistance. Methods: Forty patients (23 female patients; average age, 15.4 ± 8.7 years; age range, 6-47 years) with secundum-type ASDs were selected for this study. Cardiopulmonary bypass was achieved peripherally. Through 3-port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and ASD repair were performed by a surgeon through a thoracoscopy. Results: The cardiopulmonary bypass and aortic crossclamp times were 56.2 ± 21.1 and 38.3 ± 8.6 minutes, respectively. The length of stay in the intensive care unit was 23.0 ± 4.1 hours. There were no mortalities and no major complications in this cohort. Patients were discharged from the hospital 4 to 6 days after the operation. Transesophageal echocardiographic analysis immediately after the operation and at 30 days showed complete closure of the defect without residual shunt. Conclusions: Totally endoscopic atrial septal defect repair can be achieved without a robotically assisted surgical system. This technique is safe and effective and can be used as a therapeutic option for ASD. © 2011 by The American Association for Thoracic Surgery.
“Minimally invasive mitral valve surgery in the old patient.”
Müller, L. C., H. Hangler, et al. (2011).
European Surgery – Acta Chirurgica Austriaca 43(2): 96-98.
BACKGROUND: Minimally invasive (MICS) mitral valve surgery has become a valid alternative to the conventional approach by full median sternotomy; nevertheless, it remains unclear if the benefits, which comprehend mainly cosmesis, blood loss, ICU time, hospital stay and return to work also are true for the elderly population and may not be offset by additional complications resulting in an increased morbidity and mortality. Moreover the question remains if the diseases prevailing in the elderly population can be approached by the minimally invasive technique. METHODS: Patients 75 years or older treated in our institution from 2001 to 2009 by MICS mitral valve surgery are analyzed in respect to type of surgery (isolated mitral valve surgery or combined with tricuspid or atrial fibrillation surgery), perioperative mortality and intraoperative complications. The results are related to recent literature. RESULTS: Out of 253 MICS mitral valve procedures 30% were performed in patients >70 years, 14% in patients >75 years and 4% in patients of 80 years or older. Mortality was 1.3% in the older age group as compared to 0.8% in the total population. Valve replacement compared to valve repair was not different in the older patients (11% vs. 12.4%). CONCLUSIONS: In contrast to aortic valve surgery minimally invasive mitral operations are performed only in a relatively small percentage of elderly patients. According to our results, however, the technique can also be offered to these patients with excellent results. Results from recent literature support this finding. Reduction of surgical trauma not only improves cosmesis, but also is safe in the elderly. © 2011 Springer-Verlag.
“[Robot assisted tumor resection of an asymptomatic right atrial intracardiac lipoma; report of a case].”
Seguchi, R., N. Yashiki, et al. (2011).
Kyobu Geka (Japanese Journal of Thoracic Surgery) 64(6): 503-505.
Primary cardiac tumors are relatively rare. No therapeutic guidelines have been established for the surgical indications of such cases. This creates therapeutic dilemmas, especially when the patient is asymptomatic. We describe the robot-assisted resection of an asymptomatic right atrial lipoma. A 63-year-old female was diagnosed to have a round mobile lipoma, measuring 27 mm in diameter in the right atrium near the junction with the inferior vena cava (IVC). Although she was asymptomatic, a surgical resection was indicated since the lipoma could cause an embolism or IVC obstruction due to its morbidity and potential to enlarge. Surgery was performed using the da Vinci Surgical System. A right-sided approach was used through 4 ports. The tumor was resected with a small portion of the right atrial wall. The total operation time was 214 minutes, and the total pump time was 84 minutes. The operation was performed while the heart was beating.