“Robotic-assisted surgical myotomy in a 27-year-old man with myocardial bridging of the left anterior descending coronary artery.”
Alima, M. B., F. Vanden Eynden, et al. (2010).
Interactive Cardiovascular and Thoracic Surgery 11(2): 185-187.
Myocardial bridging (MB) is a frequent condition usually considered benign but it may be associated with myocardial ischemia. When bridging is symptomatic, therapeutic options are numerous and in the absence of guidelines all options are conceivable. This is a case of a 27-year-old man who benefited from a new surgical approach: myotomy for MB of the left anterior descending coronary artery with the help of left robotic thoracoscopy.
“Minimally invasive robotic coronary bypass on the beating heart using da Vinci S system.”
Gao, C. Q., M. Yang, et al. (2009).
Zhonghua wai ke za zhi [Chinese journal of surgery] 47(8): 570-573.
OBJECTIVE: To summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China. METHODS: Fifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography. RESULTS: All patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical conversion and surgical death. Fifty-three patients received ITA to LAD grafts and 3 patients received double coronary artery bypass grafts as well. Ten cases received stent placement in separate session. The CT scan and angiography revealed patent grafts in all patients. There were no post-operative complications. All patients were discharged from hospital. CONCLUSIONS: As a new advanced approach of revascularization, robotic ITA harvesting and coronary anastomoses can be safely performed with the da Vinci S system. The procedure is minimally invasive and can offer enhanced ability to control precise and stable operative manipulations.
“Minimally-invasive valve surgery.”
Schmitto, J. D., S. A. Mokashi, et al. (2010).
Journal of the American College of Cardiology 56(6): 455-462.
Minimally-invasive approaches have become increasingly important in cardiac valve surgery. Smaller incisions have become commonplace in many major centers. We reviewed the existing literature and present the current state-of-the-art of minimally-invasive valve operations in this paper. © 2010 American College of Cardiology Foundation.
“The Role of Intraoperative Transesophageal Echocardiography in Robotic Mitral Valve Repair.”
Wang, Y., C. Q. Gao, et al. (2010).
Echocardiography.
Background: Robotic mitral valve (MV) repair is a new surgical technique that uses small incisions. Previous studies have demonstrated the importance of intraoperative transesophageal echocardiography (TEE) for conventional MV surgery with the use of a median sternotomy incision. The aim of the present study was to delineate the utility of intraoperative TEE in robotic MV repair. Methods: Intraoperative TEE was performed in 22 consecutive patients undergoing robotic MV repair for severe degenerative mitral regurgitation (MR) over a period of 2 years. Before cardiopulmonary bypass (CPB), TEE was used to define the lesions of degenerative MR and the localization of the prolapsed leaflets, and to evaluate the severity of MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was used to assess immediately the competency of the surgical repair. Results: Agreement between TEE and surgical findings was excellent: 92.3% (kappa, 0.873) for the lesions of degenerative MR, and 98.5% (kappa, 0.943) for the localization of the prolapsed leaflets. Under TEE guidance, all the cannulae (100%) in the SVC, IVC, and AAO were placed correctly. TEE demonstrated all the patients (100%) had successful robotic MV repairs. Conclusions: Intraoperative TEE is a valuable adjunct in the assessment of robotic MV repair. (Echocardiography, ****;**:1-7).