“Inferior vena cava occluder for remote access perfusion in robotic cardiac surgery.”
Ohtake, H., S. Yamaguchi, et al. (2010).
Minim Invasive Ther Allied Technol.
Abstract Robotic cardiac surgery requires remote access perfusion. We have developed an inferior vena cava (IVC) occluder that can safely and conveniently drain blood from the IVC. This device has been clinically applied in one patient, as described herein. The framework for this device is made from a single superelastic nitinol wire, 0.30 mm in diameter. Diameter of the spreading site of the device is decided from computed tomographic images. A polyester fabric membrane (thickness 0.10 mm) is set at the tip of this framework. The occluder is deployed through an 18-F sheath. This device was used in a 64-year-old woman with lipoma in the right atrial wall near the IVC-right atrium interface. In this patient, it might not have been possible to completely reset the tumour by conventional IVC occlusion using a snare. The occluder was smoothly and safely deployed and retracted. During placement of the occluder, blood did not flow from the IVC into the right atrium. During extracorporeal circulation, vacuum drainage was performed with no air contamination. The tumour was resected by a three-arm da Vinci Surgical System((R)). The IVC occluder needs to completely block the IVC and avoid obstructing the inflow region of the hepatic vein. This device obviates the need to place a snare on the IVC, and thus should directly improve the safety of robotic cardiac surgery and shorten the operating time.
“[Anesthetic management for robot assisted off-pump construction of composite graft using the da Vinci surgical system].”
Takanashi, Y., H. Hamano, et al. (2010).
Masui 59(2): 193-196.
Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered “minimally invasive, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined.
“Successful intracardiac robotic surgery: Initial results from Japan.”
Watanabe, G. (2010).
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(1): 48-50.
Objective: The purpose of this study is to report our 2-year experience of performing endoscopic intracardiac procedures using the da Vinci Surgical System. Our teams at Kanazawa University and Tokyo Medical University groups began using the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA) in 2005. This series represents the first Japanese application of robotic technology for totally endoscopic open-heart surgery. Methods: From January 2008 to February 2009, 10 patients (mean age: 46.8 ± 16.3 years, 70% women) underwent endoscopic atrial septal defect closure and resection of the left atrial myxoma using the da Vinci Surgical System and peripheral cardiopulmonary bypass technique. Of the 10 patients, nine were classified as New York Heart Association class II and 1 patient exhibited atrial arrhythmias. In addition, two patients required mitral valve plasty (n = 2) and tricuspid annuloplasty (n = 1). Results: Mean da Vinci Surgical System working time was 140.7 ± 57.4 minutes. Mean cardiopulmonary bypass and aortic cross clamp times were 103.1 ± 37.1 and 30.0 ± 16.9 minutes, respectively. There were no conversions to sternotomy or small thoracotomy. There were no hospital deaths. Mean intensive care unit and hospital stays were 1 day and 3.1 ± 0.3 days, respectively. All patients appreciated the cosmetic result and fast recovery. Conclusions: Closed-chest atrial septal defect closure and myxoma resection performed using robotic techniques achieved excellent results and rapid postoperative recovery and provided an attractive cosmetic advantage over median sternotomy. © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.