Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation

Robotics in reproductive medicine

OBJECTIVE

To review the history, development, current applications, and future of robotic technology.

DESIGN

The MEDLINE database was reviewed for all publications on robotic technology in medicine, surgery, reproductive endocrinology, its role in surgical education, and telepresence surgery.

SETTING

University medical center.

CONCLUSION(S)

Robotic-assisted surgery is an emerging technology, which provides an alternative to traditional surgical techniques in reproductive medicine and may have a role in surgical education and telepresence surgery.

Robotic pediatric cardiac surgery: Present and future perspectives

Advances in robotic technology and imaging systems have enabled the broad application of minimally invasive techniques in cardiac surgery, including coronary artery bypass grafting and mitral valve repair in adults. In pediatric cardiac surgery, however, current robotic systems have been used primarily to facilitate thoracoscopic pediatric procedures on extracardiac lesions, such as ligation of patent ductus and division of vascular rings. The use of smaller instruments with sophisticated robotic wrists may make it possible to perform more complex extracardiac procedures even in young infants. Additionally, future technological improvements, including incorporation of tactile feedback, instrument tracking, and intracardiac imaging (such as real-time 3-dimensional echocardiography), may enable intracardiac robotic surgery to be performed in children. This article reviews the current and potential future applications of pediatric robotic surgery and the developmental work required to enable performance of these procedures, along with an overview of the problems associated with the use of current robotic surgical systems in children.

Experience on the Way to Totally Endoscopic Atrial Septal Defect Repair

BACKGROUND

Remote-access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect (ASD) and patent foramen ovale (PFO). We report on a stepwise approach to a totally endoscopic procedure.

METHODS

Seventeen patients (median age, 39 years; range, 21-55 years) underwent limited-access ASD or PFO closure. As a preparative step, the operation was carried out through minithoracotomy in 11 patients. In parallel, experience with robotic surgery was gained with totally endoscopic coronary artery bypass grafting procedures. After performance of ASD closures in dry-laboratory models using the da Vinci telemanipulation system, 6 patients were operated on in a totally endoscopic fashion.

RESULTS

With the endoscopic approach, significant learning curves were noted for cardiopulmonary bypass time y(min) = 226 - 41 * ln(x) (P = .03) and aortic cross-clamp time y(min) = 134 - 42 * ln(x) (P = .01) (x = number of procedures). There was no hospital mortality, and no residual shunts were detected at postoperative echocardiography. Median ventilation time was 9 hours (range, 0-18 hours) for the minithoracotomy group and 6 hours (range, 4-19 hours) for the totally endoscopic group. Median intensive care unit stay was 20 hours (range, 18-24 hours) and 18 hours (range, 18- 120 hours), respectively.

CONCLUSIONS

The implementation of robotic totally endoscopic closure of ASD or PFO in a heart surgery program seems to be safe. An intermediate step of performing the operations through minithoracotomy, adapting to remote access perfusion systems, and gaining experience in other robotic cardiac surgical procedures seems worthwhile. Learning curves are apparent, and adequate defect closure does not seem to be compromised by the totally endoscopic approach.