Totally Endoscopic Atrial Septal Defect Repair With Robotic Assistance

Abstract

BACKGROUND: Computer (robotic) enhancement had emerged as a facilitator of minimally invasive cardiac surgery, and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the next step in this progression-the first U.S. application of robotic technology for totally endoscopic open heart surgery. METHODS AND RESULTS: Seventeen patients underwent repair of a secundum-type atrial septal defect (n=12) or patent foramen ovale (n=5) by a totally endoscopic approach, utilizing the Da Vinci robotic system. Cardiopulmonary bypass (CPB) was achieved peripherally. Cardioplegia was administered via the distal port of the arterial cannula after endo-balloon inflation. Via three port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, atrial septopexy, and atrial closure were performed by a surgeon seated at a computer console. A fourth 15-mm port was utilized for suction and suture passage by a patient-side assistant. The mean age of the patients was 47 years (range, 22 to 68). Aortic crossclamp time was 32 minutes (median), and CPB time was 122 minutes. In 16 patients, transesophageal echocardiography after 30 days confirmed successful repair. In one patient, a recurrent shunt was identified and repaired on postoperative day 5. Median length of stay (LOS) in the intensive care unit was 20 hours, and median hospital length of stay was 4 days. CONCLUSIONS: Robotic technology can be utilized to perform open heart procedures safely and effectively via totally endoscopic approaches. This technique represents an option for patients seeking a reliable ASD repair but wishing to avoid sternotomy or thoracotomy.