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Ahmad A, El-Am EA, Mazur P, Akiki E, Sorour AA, Kurmann RD, Klarich KW, Arghami A, Rowse PG, Daly RC, Dearani JA. A Case Series of Minimally Invasive Robotic-Assisted Resection of Cardiac Papillary Fibroelastoma: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2024; 8:143-150. [PMID: 38434934 PMCID: PMC10905955 DOI: 10.1016/j.mayocpiqo.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Papillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. Surgical excision is the definitive treatment of symptomatic PFE and is conventionally performed through a median sternotomy. In this study, we report a series of 12 patients, who underwent robotic-assisted PFE removal at the Mayo Clinic. PFE involved the mitral valve, left atrium, and tricuspid valve. No major complications occurred after the procedure, and most patients were discharged 4 days after the surgery. On follow-up, 1 patient demonstrated pericarditis.
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Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Elias Akiki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ahmed A Sorour
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Reto D Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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Sandoval E, Fernández-Cisneros A, García TA, Pereda D. Robotic resection of an aortic valve fibroelastoma using a right lateral approach. J Card Surg 2021; 36:3857-3859. [PMID: 34189768 DOI: 10.1111/jocs.15781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Robotic technology provides excellent visualization and surgical precision and it is reaching maturity in cardiac surgery, although mostly confined to mitral surgery and coronary revascularization. Robotic aortic valve surgery (rAVS) has not been sufficiently developed, and experience is extremely scarce. METHODS We present a robotic resection of a papillary fibroelastoma on the aortic valve using a totally thoracoscopic right lateral approach. RESULTS This technique provides excellent exposure, facilitates patient recovery and improves cosmesis. CONCLUSIONS rAVS has tremendous potential and many patients may benefit in the future. The lateral approach used in our case may offers advantages over others previously attempted and may also facilitate adoption of rAVS by teams currently performing robotic mitral surgery.
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Affiliation(s)
- Elena Sandoval
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | | | - Tito A García
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Hirota M, Ito F, Watanabe M, Isomura T, Endo M. Minimally invasive approach for an adult patient with papillary fibroelastoma: reversed C-shaped partial sternotomy. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nisivaco SM, Patel B, Balkhy HH. Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach. J Card Surg 2019; 34:1492-1497. [DOI: 10.1111/jocs.14291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah M. Nisivaco
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
| | - Brooke Patel
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
| | - Husam H. Balkhy
- Department of Cardiothoracic Surgery University of Chicago Medicine Chicago Illinois
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Balkhy HH, Lewis CT, Kitahara H. Robot-assisted aortic valve surgery: State of the art and challenges for the future. Int J Med Robot 2018; 14:e1913. [DOI: 10.1002/rcs.1913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/26/2017] [Accepted: 03/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Husam H. Balkhy
- Section of Cardiac and Thoracic Surgery; The University of Chicago Medicine; Chicago Illinois USA
| | - Clifton T.P. Lewis
- Department of Cardiothoracic Surgery; Princeton Baptist Medical Center; Birmingham Alabama USA
| | - Hiroto Kitahara
- Section of Cardiac and Thoracic Surgery; The University of Chicago Medicine; Chicago Illinois USA
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Minimally invasive robotically assisted surgical resection of left atrial endocardial papillary fibroelastomas. J Thorac Cardiovasc Surg 2014; 148:3247-9. [DOI: 10.1016/j.jtcvs.2014.06.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 11/23/2022]
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Murphy ET. Robotic excision of aortic valve papillary fibroelastoma and concomitant maze procedure. Glob Cardiol Sci Pract 2012; 2012:93-100. [PMID: 24688994 PMCID: PMC3963717 DOI: 10.5339/gcsp.2012.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/12/2012] [Indexed: 11/30/2022] Open
Abstract
Abstract: Cardiothoracic surgeons have utilized the surgical robot to provide a minimally invasive approach to a number of intracardiac operations, including tumor resection, valve repair, and ablation of atrial arrhythmia. We report the case of a 58 year-old woman who was found to have a mobile mass on her aortic valve during evaluation of atrial fibrillation. Both of these conditions were addressed when she underwent a combined robotic biatrial Maze procedure and excision of the mass, which proved to be a papillary fibroelastoma of the aortic valve.
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Harling L, Athanasiou T, Ashrafian H, Kokotsakis J, Brown V, Nathan A, Casula R. Minimal access excision of aortic valve fibroelastoma: a case report and review of the literature. J Cardiothorac Surg 2012; 7:80. [PMID: 22943845 PMCID: PMC3494536 DOI: 10.1186/1749-8090-7-80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
Papillary fibroelastomas are rare primary tumours of cardiac origin accounting for approximately 10% of all primary cardiac neoplasms. Due to a high thromboembolic risk, surgical excision is the mainstay of treatment in these patients and median sternotomy the most widely used approach. We describe the case of a 43 year-old lady presenting with acute myocardial infarction secondary to aortic valve papillary fibroelastoma subsequently excised using a minimal access technique. From our experience mini-sternotomy offers excellent exposure and allows for safe resection in such cases, improving cosmesis without compromising either intra or post-operative outcome.
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Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, St. Mary's Campus, London, UK.
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Athanasiou T, Ashrafian H, Rowland SP, Casula R. Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption. Future Cardiol 2012; 7:511-22. [PMID: 21797747 DOI: 10.2217/fca.11.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robotic cardiac surgery utilizes the most advanced surgical technology to offer patients a minimally invasive alternative to open surgery in the treatment of a broad range of cardiac pathologies. Although robotics may offer substantial benefits to physicians, patients and healthcare institutions, there are important barriers to its adoption that includes inadequate funding, competition from alternate therapies and challenges in training. There is a growing body of evidence to demonstrate the efficacy of robotic cardiac surgery. Technological innovations are improving patient safety and expanding the indications for robotic cardiac surgery beyond the treatment of mitral valve and coronary artery disease. Robotic cardiac surgery is rapidly becoming a feasible, safe and effective option for the definitive treatment of cardiac disease in the context of 21st century challenges to healthcare provision such as diabetes, obesity and an aging population.
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Affiliation(s)
- Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College London, London W2 1NY, UK.
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Bonnichsen CR, Burkhart HM, Klarich KW, Suri RM. Surgical Resection of Mitral Valve Papillary Fibroelastoma: A Robot-Assisted, Minimally Invasive Approach with Three-Dimensional Transesophageal Echocardiography Imaging. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjcs.2012.22004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Orvieto MA, Marchetti P, Castillo OA, Coelho RF, Chauhan S, Rocco B, Ardila B, Mathe M, Patel VR. Robotic technologies in surgical oncology training and practice. Surg Oncol 2011; 20:203-9. [PMID: 21353772 DOI: 10.1016/j.suronc.2010.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons wishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties.
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Affiliation(s)
- Marcelo A Orvieto
- Florida Hospital - Celebration Health, 410 Celebration Place, Suite 200, Celebration, FL 34747, USA.
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Abstract
Minimally invasive surgery has revolutionized the surgical field over the last two decades. Robotic assisted surgery is the latest iteration towards less invasive techniques. Cardiac surgeons have slowly adapted minimally invasive and robotics techniques into their armamentarium. In particular, minimally invasive mitral valve surgery has evolved over the last decade and become the preferred method of mitral valve repair and replacement at certain specialized centres worldwide because of excellent results. We have developed a robotic mitral valve surgery program which utilizes the da Vinci® telemanipulation system allowing the surgeon to perform complex mitral valve repairs through 5mm port sites rather than a traditional median sternotomy. in this rapidly evolving field, we review the evolution and clinical results of robotically-assisted mitral valve surgery and take a look at the other cardiac surgical procedures for which da Vinci® is currently being used.
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Affiliation(s)
- E. Rodriguez
- East Carolina Heart Institute, Department of Cardiovascular Sciences East Carolina University, Greenville (NC), U.S.A
| | - W. R. Chitwood
- East Carolina Heart Institute, Department of Cardiovascular Sciences East Carolina University, Greenville (NC), U.S.A
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Woo YJ, Seeburger J, Mohr FW. Minimally Invasive Valve Surgery. Semin Thorac Cardiovasc Surg 2007; 19:289-98. [DOI: 10.1053/j.semtcvs.2007.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/11/2022]
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Ergun K, Golbasi Z, Cagli K, Altinsoy A, Mustafa Ulas M, Temucin T, Arat N, Topaloglu S, Deveci B, Ertan A. A Rare Cause of Sudden Vision Loss in a Young Male: Papillary Fibroelastoma of the Aortic Valve. Echocardiography 2007; 24:425-9. [PMID: 17381654 DOI: 10.1111/j.1540-8175.2006.00410.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiac papillary fibroelastoma (CPF) is a rare cardiac neoplasm predominantly affecting the cardiac valves. Although it is most commonly an incidental finding, it can result in life-threatening complications, such as coronary and cerebral embolism, acute valvular dysfunction, and sudden death. In this report, we describe a case of a patient with aortic valve papillary fibroelastoma, which presented with sudden vision loss due to branch retinal artery occlusion. To the best of our knowledge, this is the third case of CPF-related retinal artery embolism in English literature.
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Affiliation(s)
- Kumral Ergun
- Türkiye Yüksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
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Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery 2006; 140:263-7. [PMID: 16904978 DOI: 10.1016/j.surg.2006.05.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 04/27/2006] [Accepted: 05/06/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Robotic-assisted minimally invasive mitral valve reconstruction has gained popularity recently. Initial reports suggest that this approach can be used with relative safety and efficacy. Direct comparisons with a traditional sternotomy approach have not yet been explored extensively. METHODS All mitral valve procedures that were performed by a single surgeon during a 3-year period of time were analyzed (n = 142 procedures). Patients whose condition required concomitant coronary artery bypass grafting or aortic valve surgery were excluded subsequently from analysis, because all of these patients were approached obligatorily by sternotomy (n = 71 patients). Six patients underwent right thoracotomy mitral valve procedures without robotic assistance, and 1 patient in cardiogenic shock underwent emergent mitral valve reconstruction by sternotomy. Of the remaining 64 patients who were eligible theoretically for sternotomy or robotic-assisted minimally invasive surgery, 39 patients underwent sternotomy, and 25 patients underwent right chest minimally invasive robotic-assisted surgery. Randomization between these 2 approaches would be almost impossible in the United States. The primary determinant for the choice of approach was request of the referring physician or patient. Multiple perioperative outcomes were then compared. RESULTS Patients who underwent sternotomy and robotic-assisted surgery exhibited equivalent preoperative characteristics and experienced an equivalent degree of correction of mitral regurgitation in repairs and in need for replacement. Complex mitral valve repairs that entailed leaflet resection and reapproximation, annular plication, sliding annuloplasty, chordal transfer, and GoreTex neochordal construction were accomplished successfully with the robotic system. Cross-clamp and bypass times were longer for patients in the minimally invasive group (110 vs 151 minutes; P = .0015; 162 vs 239 minutes; P < .001, respectively). Mean packed red blood cell transfusion was lower among patients who underwent robotic-assisted surgery (5.0 vs 2.8 units; P = .04). Patients who underwent robotic-assisted surgeries experienced shorter mean duration of postoperative hospitalization (10.6 vs 7.1 days; P = .04). There was 1 death among the patients who underwent sternotomy, and no deaths among the patients who underwent robotic-assisted surgery. CONCLUSION Patients can undergo mitral valve reconstruction with minimally invasive robotic assistance, avoid a sternotomy, require less blood product transfusion, and experience shorter hospitalization.
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Affiliation(s)
- Y Joseph Woo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Woo YJ, Rodriguez E, Atluri P, Chitwood WR. Minimally Invasive, Robotic, and Off-Pump Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2006; 18:139-47. [PMID: 17157235 DOI: 10.1053/j.semtcvs.2006.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2006] [Indexed: 11/11/2022]
Abstract
A significant transformation is occurring in the management of mitral valve disease. Earlier surgery is now recommended. Mitral valve repair is the standard of care, and newer methods of reconstructing the mitral valve are developing. Surgery with videoscopic assistance can be effectively performed without sternotomy. Robotics systems are gaining wider adoption. Implantable devices to repair or replace the mitral valve off-pump and percutaneously are emerging.
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Affiliation(s)
- Y Joseph Woo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
BACKGROUND Cardiac surgery, traditionally conducted via median sternotomy, has been recently forwarded by progressively advanced technology facilitating sternal-sparing minimally invasive, access to the heart. Robotic systems, comprised of miniaturized surgical instruments mounted on long thin shafts with multiple degrees of range of motion coupled with a dual camera endoscope providing true three-dimentional high-magnification visualization have greatly propelled this field. METHODS The robotic system and the literature base pertaining to robotic cardiac surgery is reviewed in depth. RESULTS Robotic cardiac surgical procedures have been performed to repair and replace the mitral valve, bypass coronary arteries, close atrial septal defects, implant left ventricular pacing leads, and resect intracardiac tumors. CONCLUSIONS As minimally invasive and robotic surgical technology advances, so proceeds the spectrum of potential applications for robotic cardiac surgery.
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Affiliation(s)
- Y Joseph Woo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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