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Dang HQ, Le HT, Dinh LN. Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon's learning curve experience. JTCVS Tech 2024; 23:52-62. [PMID: 38352019 PMCID: PMC10859656 DOI: 10.1016/j.xjtc.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives To evaluate the safety and efficacy of the port access approach for left atrial (LA) myxoma resection and to analyze the learning curve for this procedure. Methods Thirty-six consecutive patients with LA myxoma who underwent port access surgery between April 2018 and March 2023 were enrolled in this retrospective study. The procedure included (1) unilateral or bilateral femoral artery cannulation; (2) the use of three 5-mm trocars and a 20- to 30-mm port; (3) a transseptal, biatrial, or LA approach depending on the location of the tumor base; and (4) complete or subendocardial tumor resection. CUSUM analysis was used to evaluate the aortic cross-clamp (ACC) time and cardiopulmonary bypass (CPB) time learning curves. Variables among the learning curve phases were compared. Results The average ACC and CPB times were 49 (range, 45-79) minutes and 127 (range, 120-164) minutes, respectively. There was 1 case of conversion to sternotomy due to aortic root bleeding and 1 case of unilateral pulmonary edema. CUSUMACCtime analysis included 3 phases: phase I, the initial learning period (cases 1-11); phase II, the technical competence period (cases 12-23); and phase III, the challenging period (cases 24-36). Conclusions The port access approach is safe and feasible for LA myxoma resection. According to the learning curve analysis, 11 cases are required to achieve technical competence, and 23 cases are required to address highly challenging cases.
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Affiliation(s)
- Huy Q. Dang
- Division of Minimally Invasive Cardiac Surgery, Cardiovascular Center, Hanoi Heart Hospital, Hanoi, Vietnam
| | - Huong T. Le
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Liem N. Dinh
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
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Dang HQ, Nguyen HC, Le TN. Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:574-582. [PMID: 37997659 DOI: 10.1177/15569845231208457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the Hanoi ASD procedure, which is totally endoscopic surgery for atrial septal defect (ASD) repair on beating heart. In addition, the present study also aimed to analyze the learning curve for this procedure. METHODS From May 2016 to February 2023, 198 consecutive ASD patients weighing ≥20 kg were enrolled in the retrospective study. The Hanoi ASD procedure includes (1) unilateral or bilateral femoral arterial cannulation; (2) two or three 5 mm trocars and a 15 mm port; (3) ASD repair on beating heart, preventing air embolism with CO2 insufflation and keeping the left atrium full of blood; and (4) not snaring the inferior vena cava. Cumulative sum (CUSUM) analysis was used to evaluate the cardiopulmonary bypass (CPB) and operation time learning curves. Variables among the learning curve phases were compared. RESULTS The CPB and operation times were 90 (72 to 115) min and 180 (150 to 220) min, respectively. Total drainage volume was 190 (120 to 290) mL. No endoscopic failure or major complications were complications were excluding factors causing bias, the CUSUMCPBtime analysis for the remaining 131 patients included 3 phases. Phase 1 was the initial learning period (cases 1 to 34), phase 2 represented the technical competence period (cases 35 to 54), and phase 3 was the challenging period (cases 55 to 131). CONCLUSIONS The Hanoi ASD procedure is safe and feasible for repairing ASD in patients weighing ≥20 kg. According to the learning curve analysis, 34 cases were required to achieve technical efficiency, and 54 cases were required to address highly challenging cases.
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Affiliation(s)
- Huy Q Dang
- Division of Minimally Invasive Cardiac Surgery, Cardiovascular Center, Hanoi Heart Hospital, Vietnam
| | - Huu C Nguyen
- Departments of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Thanh N Le
- Departments of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
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Davis SE, Ssemaganda H, Koola JD, Mao J, Westerman D, Speroff T, Govindarajulu US, Ramsay CR, Sedrakyan A, Ohno-Machado L, Resnic FS, Matheny ME. Simulating complex patient populations with hierarchical learning effects to support methods development for post-market surveillance. BMC Med Res Methodol 2023; 23:89. [PMID: 37041457 PMCID: PMC10088292 DOI: 10.1186/s12874-023-01913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Validating new algorithms, such as methods to disentangle intrinsic treatment risk from risk associated with experiential learning of novel treatments, often requires knowing the ground truth for data characteristics under investigation. Since the ground truth is inaccessible in real world data, simulation studies using synthetic datasets that mimic complex clinical environments are essential. We describe and evaluate a generalizable framework for injecting hierarchical learning effects within a robust data generation process that incorporates the magnitude of intrinsic risk and accounts for known critical elements in clinical data relationships. METHODS We present a multi-step data generating process with customizable options and flexible modules to support a variety of simulation requirements. Synthetic patients with nonlinear and correlated features are assigned to provider and institution case series. The probability of treatment and outcome assignment are associated with patient features based on user definitions. Risk due to experiential learning by providers and/or institutions when novel treatments are introduced is injected at various speeds and magnitudes. To further reflect real-world complexity, users can request missing values and omitted variables. We illustrate an implementation of our method in a case study using MIMIC-III data for reference patient feature distributions. RESULTS Realized data characteristics in the simulated data reflected specified values. Apparent deviations in treatment effects and feature distributions, though not statistically significant, were most common in small datasets (n < 3000) and attributable to random noise and variability in estimating realized values in small samples. When learning effects were specified, synthetic datasets exhibited changes in the probability of an adverse outcomes as cases accrued for the treatment group impacted by learning and stable probabilities as cases accrued for the treatment group not affected by learning. CONCLUSIONS Our framework extends clinical data simulation techniques beyond generation of patient features to incorporate hierarchical learning effects. This enables the complex simulation studies required to develop and rigorously test algorithms developed to disentangle treatment safety signals from the effects of experiential learning. By supporting such efforts, this work can help identify training opportunities, avoid unwarranted restriction of access to medical advances, and hasten treatment improvements.
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Affiliation(s)
- Sharon E Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, USA.
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA
| | - Jejo D Koola
- UC Health Department of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr. MC 0728, La Jolla, San Diego, CA, 92093-0728, USA
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | - Dax Westerman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, USA
| | - Theodore Speroff
- Departments of Medicine and Biostatistics, Vanderbilt University Medical Center, 1313 21St Avenue South, Oxford House, Room 209, Nashville, TN, 37232, USA
| | - Usha S Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, 3rd Floor, Aberdeen, AB25 2ZD, UK
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | - Lucila Ohno-Machado
- Biomedical Informatics and Data Science, Yale School of Medicine, 100 College Street, New Haven, CT, 06510, USA
| | - Frederic S Resnic
- Division of Cardiovascular Medicine and Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Michael E Matheny
- Departments of Biomedical Informatics, Biostatistics, and Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, 1310 24th Avenue South, Nashville, TN, 37212, USA
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Nguyen UH, Dang HQ, Nguyen HC, Le TN. Intermediate-Term Outcomes of Totally Endoscopic Atrial Septal Defect Repair on Beating Heart in Small Children. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:223-230. [PMID: 35699726 DOI: 10.1177/15569845221102179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Manipulation in a narrow surgical field and risks of femoral arterial (FA) complications are difficulties when applying totally endoscopic surgery (TES) for congenital heart disease in small children. This study was conducted to investigate the feasibility of TES for atrial septal defect (ASD) repair in children weighing 13 to 20 kg. Methods: From July 2016 to July 2021, 14 patients with a mean age of 5.4 ± 2.2 years and mean weight of 15.57 ± 2.39 kg (range, 13 to 20 kg), underwent TES for ASD repair on the beating heart. FA cannulation was established through a Dacron graft. An additional FA cannula (2 to 4 Fr smaller than the expected size) was placed into the left FA in case of increasing arterial pressure. Three 5 or 5.5 mm trocars and one 12 mm port were used. The surgical field was filled with CO2. No aortic clamp, no aortic root needle, and no snaring of the inferior vena cava were used. The mean follow-up time was 37.9 ± 12.5 months. Results: Cardiopulmonary bypass (CPB) installation time, CPB time, and operation time were 42.6 ± 16.5 min, 113.1 ± 33.1 min, and 209.6 ± 50.6 min, respectively. Total drainage volume was 125.4 ± 89.2 mL. Patients did not need analgesics on day 4 or 5 after surgery. No severe complications, including arterial complications, were recorded during follow-up. Conclusions: By optimizing the surgical field and setting the FA cannula correctly, TES for ASD closure is feasible in small children weighing between 13 and 20 kg.
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Affiliation(s)
- Uoc H Nguyen
- Departments of Cardiovascular and Thoracic Surgery, Cardiovascular and Thoracic Center, 435680Viet Duc Hospital, Hanoi, Vietnam
| | - Huy Q Dang
- Minimally Invasive Cardiac Surgery Unit, Cardiovascular Center, 434418Hanoi Heart Hospital, Vietnam
| | - Huu C Nguyen
- Departments of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Thanh N Le
- Departments of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
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Cerny S, Oosterlinck W, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, Pettinari M, Van Praet F, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Gianoli M, Agnino A, Philipsen T, Jansens JL, Folliguet T, Palmen M, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van den Eynde J, Bonatti J. Robotic Cardiac Surgery in Europe: Status 2020. Front Cardiovasc Med 2022; 8:827515. [PMID: 35127877 PMCID: PMC8811127 DOI: 10.3389/fcvm.2021.827515] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent. Methods Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program. Results During a 4-year period (2016–2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days. Conclusion Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.
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Affiliation(s)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- *Correspondence: Wouter Oosterlinck
| | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | | | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assitance Publique/Hopitaux de Paris, Paris, France
| | | | | | | | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Jef Van den Eynde
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Jef Van den Eynde
| | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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Lee B, Choi Y, Cho JY, Yoon YS, Han HS. Initial experience with a robotic hepatectomy program at a high-volume laparoscopic center: single-center experience and surgical tips. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1132. [PMID: 34430573 PMCID: PMC8350693 DOI: 10.21037/atm-21-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/23/2021] [Indexed: 01/16/2023]
Abstract
Background Despite the development of laparoscopic surgery, there are still inherent limitations associated with conventional laparoscopic instruments such as restrictions in movement and an inability for articulation. Robotic surgery may help to overcome the limitations of conventional laparoscopic surgery. The aim of this study was to present our initial experience with robotic hepatectomy (RH) and discuss the steps required to develop an RH program at a high-volume laparoscopic hepatectomy (LH) center. Methods We retrospectively reviewed prospectively collected data for 14 consecutive patients who underwent RH between 2017 and 2018. Clinicopathological characteristics and perioperative outcomes were compared with those reported in previous studies. The operation time of each procedure was analyzed to assess RH proficiency based on experience. Results Of the 14 patients, 12 patients (85.7%) underwent robotic major hepatectomy. Median patient age was 54.5 years, while median body mass index (BMI) was 25.2 kg/m2. The median operation time was 360 (range: 145–544) min. The median estimated blood loss (EBL) was 300 (range: 50–1,400) mL. Conversion to open surgery was not required in any case. The median length of hospital stay was 5 (range: 4–14) days. Major complications occurred in 2 patients (14.2%), although both recovered without sequelae. The time required for hilar dissection, docking, and parenchymal transection gradually decreased after the first two cases of RH. Conclusions From our initial experience, RH might be considered as a feasible procedure in the liver resection, even in major hepatectomy. In addition, surgeons with sufficient experience in LH could rapidly adapt for RH. However, we have to make a system for education and monitoring of this innovative surgery for the patients’ safety.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Huang LC, Xu QC, Chen DZ, Dai XF, Chen LW. Hospital outcome of concomitant tricuspid annuloplasty during totally endoscopic mitral valve surgery: a propensity matched study. J Thorac Dis 2021; 13:3042-3050. [PMID: 34164195 PMCID: PMC8182534 DOI: 10.21037/jtd-20-3302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background This study aimed to determine how concomitant tricuspid annuloplasty (TAP) affects the clinical outcomes of patients undergoing totally endoscopic mitral valve surgery. Methods This was a single-centre, retrospective study. Between January 2019 and June 2020, 143 patients who underwent totally endoscopic mitral valve surgery in our institution were enrolled. Ninety-two patients who underwent isolated mitral valve surgery were categorized into the minimally invasive mitral valve surgery (MIMVS) group (n=92), and patients who underwent mitral valve surgery with concomitant TAP were categorized into the MIMVS-TAP (n=51) group. Clinical data were collected from all patients, including demographic and perioperative data. We conducted propensity score matching (PSM) by using one-to-one ratio nearest-neighbour matching for baseline demographic data and tricuspid valve-related parameters. Forty patients in each group were matched in this way. Parametric and nonparametric tests were performed for data analysis. Results Statistically, postoperative mortality within 30 days was not significantly different between the two groups (P=1). No differences were found in serious adverse events, such as stroke or third-degree conduction block, between the two groups after 1:1 PSM (P=1 and P=0.480, respectively). The mean operation time for the MIMVS+TAP group was longer (232.13±36.05 min) than that for the MIMVS group (204.25±28.49 min; P<0.001). The same was true for the cardiopulmonary bypass (CPB) time (169.48±25.96 vs. 153.10±23.00 min; P=0.004) and aortic clamp time (110.80±17.37 vs. 101.00±14.38 min; P=0.005). The duration of the intensive care unit stay and the overall postoperative length of stay were not different between the two groups (P=0.734 and P=0.472, respectively). The postoperative systolic pulmonary artery pressure differed between the two groups [38.00±8.45 (MIMVS); 33.65±7.34 (MIMVS + TAP), P=0.022]. Conclusions Our study showed that totally endoscopic mitral valve surgery with concomitant TAP is just as safe and effective as isolated totally endoscopic mitral valve surgery, even with a long surgery duration. Our study also suggested that totally endoscopic mitral valve surgery with concomitant TAP can improve tricuspid function in patients.
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Affiliation(s)
- Ling-Chen Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Cardio-thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Qi-Chen Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Dao-Zhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Cardio-thoracic Surgery, Fujian Medical University, Fuzhou, China
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Güllü AÜ, Senay S, Kocyigit M, Zencirci E, Akyol A, Degirmencioglu A, Karakus G, Ersin E, Karabiber A, Alhan C. An analysis of the learning curve for robotic-assisted mitral valve repair. J Card Surg 2021; 36:624-628. [PMID: 33403721 DOI: 10.1111/jocs.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. METHOD Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. RESULT There were 23 (38.3%) men and 37 (61.7%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0%), anterior leaflet prolapsus (n = 8, 13.3%), Barlow disease (n = 3, 5%), and annular dilatation (n = 7, 11.6%). The patients underwent notochordal implantation (n = 27, 45%), quadrangular or triangular resection (n = 23, 38.3%), isolated ring annuloplasty (n = 7, 11.7%), resection, and leaflet reduction (n = 2, 3.3%) or edge to edge repair (n = 1, 1.7%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min [p = .00], 102.3 vs. 80 min [p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. CONCLUSION The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.
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Affiliation(s)
- Ahmet Ü Güllü
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Sahin Senay
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Ertugrul Zencirci
- Department of Cardiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Akyol
- Department of Cardiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Aleks Degirmencioglu
- Department of Cardiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Gultekin Karakus
- Department of Cardiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Egemen Ersin
- Department of Cardiovascular Surgery, Programme of Perfusion, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Alara Karabiber
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
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Onan B, Onan IS. Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients. Ann Thorac Surg 2020; 112:2020-2027. [DOI: 10.1016/j.athoracsur.2020.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
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Ravikumar N, George V, Shirke MM, Ashry A, Harky A. Robotic coronary artery surgery: Outcomes and pitfalls. J Card Surg 2020; 35:3108-3115. [DOI: 10.1111/jocs.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Nidhruv Ravikumar
- Department of Medicine, School of Medicine Queen's University Belfast Belfast UK
| | - Varghese George
- Department of Medicine, School of Medicine Queen's University Belfast Belfast UK
| | - Manasi M. Shirke
- Department of Medicine, School of Medicine Queen's University Belfast Belfast UK
| | - Amr Ashry
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Liverpool UK
- Department of Cardiothoracic Surgery Assiut University Hospital Assiut Egypt
| | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Liverpool UK
- Department of Integrative Biology, Faculty of Life Sciences University of Liverpool Liverpool UK
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
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Torregrossa G, Hibino N, Amabile A, Balkhy HH. Robotic Surgery in the Adult Congenital Cardiac Patient: Back to the Future? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:99-100. [PMID: 32352898 DOI: 10.1177/1556984520909802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gianluca Torregrossa
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Narutoshi Hibino
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Andrea Amabile
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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Aydin U, Sen O, Kadirogullari E, Kahraman Z, Onan B. Robotic Mitral Valve Surgey Combined with Left Atrial Reduction and Ablation Procedures. Braz J Cardiovasc Surg 2019; 34:285-289. [PMID: 31310466 PMCID: PMC6629224 DOI: 10.21470/1678-9741-2018-0297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF). METHODS Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients' demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients. RESULTS All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m2, ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m2 (P=0.008), EF to 50.63±10.13% (P>0.05), and PAP to 39.02±3.11 mmHg (P=0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up. CONCLUSION Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.
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Affiliation(s)
- Unal Aydin
- Cardiovascular Surgery Training and Research Hospital Cardiovascular Surgery Department İstanbul Turkey İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, İstanbul, Turkey
| | - Onur Sen
- Cardiovascular Surgery Training and Research Hospital Cardiovascular Surgery Department İstanbul Turkey İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, İstanbul, Turkey
| | - Ersin Kadirogullari
- Cardiovascular Surgery Training and Research Hospital Cardiovascular Surgery Department İstanbul Turkey İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, İstanbul, Turkey
| | - Zeynep Kahraman
- Cardiovascular Surgery Training and Research Hospital Anesthesiology Department İstanbul Turkey İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Anesthesiology Department, İstanbul, Turkey
| | - Burak Onan
- Cardiovascular Surgery Training and Research Hospital Cardiovascular Surgery Department İstanbul Turkey İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, İstanbul, Turkey
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Robotic repair of partial anomalous pulmonary venous connection: the initial experience and technical details. J Robot Surg 2019; 14:101-107. [DOI: 10.1007/s11701-019-00943-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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14
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Tang Y, Wu Y, Zhu J, Liu X, Zhou J, Huang H, Li M, Dai Y, Han X. Total endoscopic repair of atrial septal defect under on-pump beating heart. J Thorac Dis 2019; 10:6557-6562. [PMID: 30746200 DOI: 10.21037/jtd.2018.10.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. Methods From 2010 to 2017, 161 patients with a mean age of 28.31±12.34 years who underwent non-robotically assisted total thoracoscopic closure for ASD were included in this study, and those patients were also divided into two groups, including group A and group B. In group A, 115 patients underwent the procedure on beating hearts without aorta cross-clamped; in group B, 46 patients underwent the procedure on hearts arrested with cardioplegia with aorta cross-clamped. Cardiopulmonary bypass (CPB) was peripherally achieved as well. Results Total thoracoscopic ASD closures were successfully performed without in-hospital mortality or other serious complications in all patients of both groups. Dacron or bovine patches were used in 81 and 32 patients in the two groups, respectively. Duration of operation, duration of CPB, aorta cross-clamped time, duration of mechanical ventilation, the length of intensive care unit (ICU) and post-operative hospital stay in group A, were all shorter than those in group B (P<0.05). There was no statistically significant difference in blood transfusion during operation or post-operation thoracic drainage. During follow-up, echocardiograms at 3, 30, 90 and 365, showed no residual shunt or tricuspid regurgitation. Conclusions Total thoracoscopic closure of ASD without assistance of a surgical robotic system on beating heart is safe and feasible and can be used as a therapeutic option for ASD, and by using the mentioned technique, less injuries are applied to patients.
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Affiliation(s)
- Yihu Tang
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yanhu Wu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jinfu Zhu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xiang Liu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jinxin Zhou
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Haobing Huang
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Mingke Li
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yawei Dai
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xu Han
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
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Onan B, Aydin U, Kadirogullari E, Onan IS, Sen O. Totally Endoscopic Robotic‐Assisted Cardiac Surgery in Children. Artif Organs 2018; 43:342-349. [DOI: 10.1111/aor.13357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Burak Onan
- Cardiovascular Surgery, Pediatric Cardiac Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Turkey
| | - Unal Aydin
- Cardiovascular Surgery, Pediatric Cardiac Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Turkey
| | - Ersin Kadirogullari
- Cardiovascular Surgery, Pediatric Cardiac Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Turkey
| | - Ismihan Selen Onan
- Cardiovascular Surgery, Pediatric Cardiac Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Turkey
| | - Onur Sen
- Cardiovascular Surgery, Pediatric Cardiac Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital Istanbul Turkey
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The role of robotics in cardiac surgery: a systematic review. J Robot Surg 2018; 13:41-52. [PMID: 30255360 DOI: 10.1007/s11701-018-0875-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/20/2018] [Indexed: 12/23/2022]
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Yanagisawa J, Maekawa A, Sawaki S, Tokoro M, Ozeki T, Orii M, Saiga T, Ito T. Three-port totally endoscopic repair vs conventional median sternotomy for atrial septal defect. Surg Today 2018; 49:118-123. [PMID: 30238158 DOI: 10.1007/s00595-018-1713-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSES We assessed the validity of three-port totally endoscopic repair (3PTER) for atrial septal defect (ASD). METHODS Between February, 2000 and November, 2017, 151 patients underwent surgery for ASD. Forty-seven patients underwent 3PTER as minimally invasive cardiac surgery (MICS) and 104 patients underwent conventional median sternotomy (CMS). Propensity matching yielded 94 matched patients (47 vs 47). We compared the early results between the groups. The 3PTER technique was performed with the patient in the partial left lateral position, under cardio-pulmonary bypass (CPB) established through a groin incision. The three ports consisted of a main incision (3 cm), a trocar for the left-handed instrument, and a camera port in right antero-lateral chest. RESULTS MICS needed longer cross clamp and CPB times (57, 48-86 vs 24, 16-30 min, p < 0.01 and 115, 106-131 vs 53, 43-80 min, p < 0.01, respectively)*, although the operation time and hospital stay were significantly shorter (180, 159-203 vs 190, 161-225 min, p = 0.024 and 6.0, 6-8 vs 15, 13-19 days, p < 0.01, respectively)*. The intra-operative and postoperative bleeding were significantly less in MICS than CMS (20, 5-40 vs 225, 130-287.5 p < 0.01 and 200, 145-290 vs 340, 250-535 ml, p < 0.01, respectively)*. *: median, 25th-75th percentile. CONCLUSION Irrespective of the longer CPB and cross-clamp time than for CMS, MICS had a shorter operation time, less bleeding, and resulted in quicker recovery. The 3PTER was safe and cosmetically excellent.
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Affiliation(s)
- Junji Yanagisawa
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan.
| | - Atsuo Maekawa
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Sadanari Sawaki
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Masayoshi Tokoro
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Takahiro Ozeki
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Mamoru Orii
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Toshiyuki Saiga
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nagoya, 453-8511, Japan
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Abstract
Surgical repair of an atrial septal defect (ASD) is a safe and effective operation with little to no morbidity and mortality. In an effort to reduce the trauma of surgery, current approaches focus on less invasive surgical techniques, rather than the intracardiac repair. We will describe the different types of ASD, techniques for repair, and options for minimally invasive repair.
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Affiliation(s)
- Matthew Liava'a
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - David Kalfa
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
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Ishikawa N, Watanabe G, Tarui T. No-touch aorta robot-assisted atrial septal defect repair via two ports. Interact Cardiovasc Thorac Surg 2018; 26:721-724. [PMID: 29300963 DOI: 10.1093/icvts/ivx385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/12/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Atrial septal defect (ASD) repairs have been successfully performed on arrested hearts with robotic assistance. The present study assessed the feasibility, safety, and efficacy of totally endoscopic cardiac surgery using a no-touch aorta technique for ASD via only 2 ports, and we named this procedure two-port robotic cardiac surgery (TROCS). METHODS Between May 2014 and June 2016, 8 consecutive patients underwent TROCS for ASD using the da Vinci surgical system (Intuitive Surgical Inc.) at our institute. All of the procedures were performed via only 2 port incisions in the right chest. One was the camera port, and the other was the port for the robotic instruments. Both robotic instruments were inserted through this port and crossed while being prevented from colliding with each other. The surgeon console was set to the reverse of default settings so that both masters would control the inverse instrument. TROCS for ASD was carried out under ventricular fibrillation induced by combinations of an electrical fibrillator, injection of potassium, and hypothermia without aortic cross-clamping. RESULTS All cases were successfully repaired. The mean operation, cardiopulmonary bypass and ventricular fibrillation times were 129.6 ± 29.0 min, 66.9 ± 24.5 min and 9.6 ± 5.9 min, respectively, and the estimated blood loss volume was 28.1 ± 58.6 ml. No patients required blood transfusion during their hospital stay, and their cosmetic results were excellent. CONCLUSIONS TROCS for ASD using no-touch aorta technique was achieved safely with good clinical results and excellent cosmetic results.
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Affiliation(s)
- Norihiko Ishikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Suginami-ku, Tokyo, Japan
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Suginami-ku, Tokyo, Japan
| | - Tatsuya Tarui
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Suginami-ku, Tokyo, Japan
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Arkhipov AN, Bogachev-Prokofiev AV, Zubritskiy AV, Khapaev TS, Gorbatykh YN, Pavlushin PM, Karaskov AM. [Robot-assisted atrial septal defect closure in adults: first experience in Russia]. Khirurgiia (Mosk) 2018:4-20. [PMID: 29460874 DOI: 10.17116/hirurgia201824-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze immediate results of minimally invasive robot-assisted atrial septal defect (ASD) closure in adults. MATERIAL AND METHODS For the period from March 2012 to November 2016 sixty patients with contraindications to endovascular procedure have undergone robot-assisted atrial septal defect closure at Meshalkin Siberian Federal Biomedical Research Center. Mean age was 34.5±11.3 years, body mass index - 24.6±4.0 kg/m2. 48 (80%) patients had NYHA class II before surgery. In 37 (61.7%) patients isolated ASD with deficiency or absence of one edge was diagnosed, isolated ASD with primary septum aneurysm - in 16 (26.7%) cases, 7 (11.6%) patients had reticulate ASD. 5 (8.3%) patients had concomitant tricuspid valve insufficiency required surgical repair (suture annuloplasty). All operations were performed under cardiopulmonary bypass with peripheral cannulation. Right-sided anterolateral mini-thoracotomy was used in the first 43 patients. Following 17 patients underwent completely endoscopic procedure. Depending on the shape, size and anatomical features of the defect we performed suturing (14 patients, 23.3%) or repair with xenopericardial patch (46%, 76.6%). RESULTS Mean CPB and aortic cross-clamping time was 89.1±28.7 and 24.8±9.5 min, respectively. Postoperative variables: mechanical ventilation 3.3±1.5 hours, ICU-stay - 18.2±3.7 hours, postoperative hospital-stay - 13.4±5.7 days. There were no mortality and any life-threatening intra- and postoperative complications. Cases of conversion to thoraco-/sternotomy and postoperative bleeding followed by redo surgery were also absent. 23 patients were followed-up within 1 year, 6 patients - within 2 years, 3 patients - within 3 years. All patients were in NYHA class I-II with 100% freedom from ASD recanalization and redo surgery. According to echocardiography data there were decreased right heart, pulmonary artery pressure and preserved left ventricular function in early postoperative period and 1 year after surgery. CONCLUSION In view of favorable course of postoperative period, no significant specific complications and encouraging immediate results we can talk about endoscopic robot-assisted ASD closure in adults as a safe and effective alternative to surgical treatment.
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Affiliation(s)
- A N Arkhipov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Bogachev-Prokofiev
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Zubritskiy
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - T S Khapaev
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - Yu N Gorbatykh
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - P M Pavlushin
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A M Karaskov
- Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
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Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart Without Robotic Assistance in 25 Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:446-452. [PMID: 29232303 PMCID: PMC5737448 DOI: 10.1097/imi.0000000000000436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Objective The aim of the study was to investigate the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for atrial septal defect (ASD) closure on beating hearts. Methods Twenty-five patients (adults/children: 15/10) underwent ASD closure using nonrobotically assisted totally endoscopic approach on beating heart. Three 5-mm trocars and one 12-mm trocar were used, only the superior vena cava is snared, filling the pleural and pericardial cavities with CO2, and the heart was beating during the surgery. Twenty-three patients had isolated secundum ASD (2 of which had severe tricuspid regurgitation) and two patients had ASD combined with partial anomalous pulmonary venous connection. All ASDs were closed using artificial patch, continuous suture; tricuspid regurgitations were repaired and the anomalous pulmonary veins were drained to the left atrium. Results No postoperative complications or deaths occurred. Mean ± SD operation time and mean cardiopulmonary bypass time were 267.2 ± 44.6 and 156.1 ± 33.6 min, respectively. These patients were extubated within the first 5 hours, and the volume of blood drainage on the first day was less than 80 mL. Four days after surgery, patients did not need analgesics and were able to return to normal activities 1 week postoperatively. Conclusions Totally endoscopic operation for ASD closure on beating heart is safe, with short recovery period, and surgical scars are of high cosmetic value, especially in a woman and girl.
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Goodman A, Koprivanac M, Kelava M, Mick SL, Gillinov AM, Rajeswaran J, Brzezinski A, Blackstone EH, Mihaljevic T. Robotic Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Avi Goodman
- Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Marta Kelava
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Stephanie L. Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH USA
| | - Anna Brzezinski
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH USA
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
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Robotic Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:390-397. [DOI: 10.1097/imi.0000000000000438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective Adoption of robotic mitral valve surgery has been slow, likely in part because of its perceived technical complexity and a poorly understood learning curve. We sought to correlate changes in technical performance and outcome with surgeon experience in the “learning curve” part of our series. Methods From 2006 to 2011, two surgeons undertook robotically assisted mitral valve repair in 458 patients (intent-to-treat); 404 procedures were completed entirely robotically (as-treated). Learning curves were constructed by modeling surgical sequence number semiparametrically with flexible penalized spline smoothing best-fit curves. Results Operative efficiency, reflecting technical performance, improved for (1) operating room time for case 1 to cases 200 (early experience) and 400 (later experience), from 414 to 364 to 321 minutes (12% and 22% decrease, respectively), (2) cardiopulmonary bypass time, from 148 to 102 to 91 minutes (31% and 39% decrease), and (3) myocardial ischemic time, from 119 to 75 to 68 minutes (37% and 43% decrease). Composite postoperative complications, reflecting safety, decreased from 17% to 6% to 2% (63% and 85% decrease). Intensive care unit stay decreased from 32 to 28 to 24 hours (13% and 25% decrease). Postoperative stay fell from 5.2 to 4.5 to 3.8 days (13% and 27% decrease). There were no in-hospital deaths. Predischarge mitral regurgitation of less than 2+, reflecting effectiveness, was achieved in 395 (97.8%), without correlation to experience; return-to-work times did not change substantially with experience. Conclusions Technical efficiency of robotic mitral valve repair improves with experience and permits its safe and effective conduct.
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Dang QH, Le NT, Nguyen CH, Tran DD, Nguyen DH, Nguyen TH, Ngo THL. Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart without Robotic Assistance in 25 Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Quang-Huy Dang
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Ngoc-Thanh Le
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Cong-Huu Nguyen
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Dac-Dai Tran
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Do-Hung Nguyen
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Trung-Hieu Nguyen
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Thi-Hai-Linh Ngo
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, E Hospital, Hanoi, Vietnam
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25
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Zubair MH, Smith JM. Updates in Minimally Invasive Cardiac Surgery for General Surgeons. Surg Clin North Am 2017; 97:889-898. [DOI: 10.1016/j.suc.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Burkhart HM, Suri RM. Minimally invasive video assisted surgical closure of secundum atrial septal defect. Ann Cardiothorac Surg 2017; 6:60-63. [PMID: 28203543 DOI: 10.21037/acs.2017.01.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rakesh M Suri
- Department of Cardiothoracic and Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Jung JC, Kim KH. Minimally Invasive Cardiac Surgery versus Conventional Median Sternotomy for Atrial Septal Defect Closure. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:421-426. [PMID: 27965918 PMCID: PMC5147466 DOI: 10.5090/kjtcs.2016.49.6.421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/10/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Median sternotomy is the standard approach for atrial septal defect (ASD) closure. However, minimally invasive cardiac surgery (MICS) has been introduced at many centers in adult/grown-up congenital heart patients. We retrospectively reviewed the results of right anterolateral thoracotomy compared with conventional median sternotomy (CMS) for ASD closure at Seoul National University Hospital. METHODS We retrospectively analyzed 60 adult patients who underwent isolated ASD closure from January 2004 to December 2013 (42 in the CMS group, 18 in the MICS group). Preoperative, operative, and postoperative data were collected and compared between the 2 groups. RESULTS The MICS group was younger (44.6 years vs. 32.4 years, p=0.002) and included more females (66.7% vs. 94.4%, p=0.025) than the CMS group. Operation time (188.4 minutes vs. 286.7 minutes, p<0.001), cardiopulmonary bypass time (72.7 minutes vs. 125.8 minutes, p<0.001), and aortic cross-clamp time (25.5 minutes vs. 45.6 minutes, p<0.001) were significantly longer in the MICS group. However, there were no significant differences in morbidity and mortality between groups. Only chest tube drainage in the first 24 hours (627.1 mL vs. 306.1 mL, p<0.001) exhibited a significant difference. CONCLUSION MICS via right anterolateral thoracotomy is an alternative choice for ASD closure. The results demonstrated similar morbidity and mortality between groups, and favored MICS in chest tube drainage in the first 24 hours.
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Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
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Gil-Jaurena JM, Pérez-Caballero R, Pita-Fernández A, González-López MT, Sánchez J, De Agustín JC. How to set-up a program of minimally-invasive surgery for congenital heart defects. Transl Pediatr 2016; 5:125-133. [PMID: 27709093 PMCID: PMC5035755 DOI: 10.21037/tp.2016.06.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mid-line sternotomy is the commonest incision for cardiac surgery. Alternative approaches are becoming fashionable in many centres, amidst some reluctance because of learning curves and overall complexity. Our recent experience in starting a new program on minimally invasive pediatric cardiac surgery is presented. The rationale for a stepwise onset and the short-medium term results for a three-year span are displayed. METHODS A three-step schedule is planned: First, an experienced surgeon (A) starts performing simple cases. Second, new surgeons (B, C, D, E) are introduced to the minimally invasive techniques according to their own proficiency and skills. Third, the new adopters are enhanced to suggest and develop further minimally invasive approaches. Two quality markers are defined: conversion rate and complications. RESULTS In part one, surgeon A performs sub-mammary, axillary and lower mini-sternotomy approaches for simple cardiac defects. In part two, surgeons B, C, D and E are customly introduced to such incisions. In part three, new approaches such as upper mini-sternotomy, postero-lateral thoracotomy and video-assisted mini-thoracotomy are introduced after being suggested and developed by surgeons B, C and E, as well as an algorithm to match cardiac conditions and age/weight to a given alternative approach. The conversion rate is one out of 148 patients. Two major complications were recorded, none of them related to our alternative approach. Four minor complications linked to the new incision were registered. The minimally invasive to mid-line sternotomy ratio rose from 20% in the first year to 40% in the third year. CONCLUSIONS Minimally invasive pediatric cardiac surgery is becoming a common procedure worldwide. Our schedule to set up a program proves beneficial. The three-step approach has been successful in our experience, allowing a tailored training for every new surgeon and enhancing the enthusiasm in developing further strategies on their own. Recording conversion-rates and complications stands for quality standards. A twofold increase in minimally invasive procedures was observed in two years. The short-medium term results after three years are excellent.
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Affiliation(s)
- Juan-Miguel Gil-Jaurena
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ramón Pérez-Caballero
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Pita-Fernández
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María-Teresa González-López
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jairo Sánchez
- Department of Pediatric Cardiac Surgery, Instituto Cardiológico, Bucaramanga, Colombia
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Pathway for Surgeons and Programs to Establish and Maintain a Successful Robot-Assisted Adult Cardiac Surgery Program. Ann Thorac Surg 2016; 102:340-4. [DOI: 10.1016/j.athoracsur.2016.02.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 11/22/2022]
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Pathway for surgeons and programs to establish and maintain a successful robot-assisted adult cardiac surgery program. J Thorac Cardiovasc Surg 2016; 152:9-13. [DOI: 10.1016/j.jtcvs.2016.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 11/21/2022]
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Robotic atrial septal defect closure and tricuspid annuloplasty in a case of situs inversus totalis with dextrocardia. J Robot Surg 2016; 11:87-90. [DOI: 10.1007/s11701-016-0619-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/13/2016] [Indexed: 01/03/2023]
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Gil-Jaurena JM, González-López MT, Pérez-Caballero R, Pita A, Castillo R, Miró L. 15 years of minimally invasive paediatric cardiac surgery; development and trends. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gil-Jaurena JM, González-López MT, Pérez-Caballero R, Pita A, Castillo R, Miró L. [15 years of minimally invasive paediatric cardiac surgery; development and trends]. An Pediatr (Barc) 2015. [PMID: 26216279 DOI: 10.1016/j.anpedi.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The minimally invasive approach is seldom reported in paediatric cardiac surgery. Teams gathering experience are scarce, with programs focused on simple cases. The experience is presented on a series of over 200 cases operated on in the past 15 years. MATERIAL AND METHODS A sub-mammary approach program was started in 2000, which was gradually extended to include more complex and younger patients. The axillary incision was adopted in 2009, following the same steps. In 2013, the mini-sternotomy incision was introduced, increasing our armamentarium. From July 2000 until December 2014, 203 patients were operated on. The sub-mammary approach was used in 102 cases, axillary in 50 patients, mini-sternotomy in 44, postero-lateral thoracotomy in 4 cases, and upper mini-sternotomy in 3. RESULTS By diagnosis, ostium secundum atrial septal defect was the most common (128), followed by sinus venosus (20), ventricular septal defect (20), ostium primum (16), and others (19). One patient was converted to sternotomy. No neurological events were detected. The mean age was 7.8/3.7 and 1.8 years, and the mean weight was 28.1/16.1 and 9.4 Kg. in the sub-mammary, axillary and mini-sternotomy approaches, respectively. The aesthetic results were excellent. CONCLUSIONS Based on our 15 years of experience, minimally invasive surgery is safe and yields excellent cosmetic results. The gradual introduction of alternative approaches (sub-mammary, axillary, mini-sternotomy) allowed us to set-up guidelines and learning curves. The wide range of incisions enables the most appropriate one to be selected depending on age/weight and cardiac condition.
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Affiliation(s)
| | | | | | - Ana Pita
- Cirugía Cardiaca Infantil, Hospital Gregorio Marañón, Madrid, España
| | - Rafael Castillo
- Cirugía Cardiaca Infantil, Hospital Carlos Haya Málaga, Málaga, España
| | - Luis Miró
- Cirugía Cardiaca Infantil, Hospital Valle de Hebrón, Barcelona, España
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Robotic repair of sinus venosus atrial septal defect with partial anomalous pulmonary venous return and persistent left superior vena cava. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 9:388-90. [PMID: 25238426 DOI: 10.1097/imi.0000000000000093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of partial anomalous pulmonary venous return and/or persistent left superior vena cava (LSVC) is usually viewed as a contraindication for robotic repair of complex atrial septal defects, such as those of the sinus venosus type. Three patients, aged 29, 73, and 23 years, successfully underwent totally endoscopic, robotic-assisted repair of sinus venosus-type atrial septal defect with partial anomalous pulmonary venous return and persistent LSVC. Two different techniques--direct cannulation or placement of a sump sucker--were successfully used to manage venous return from the persistent LSVC.
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Zhang Q, Zhou ZC, Lin M, Wang HT, Zhao ZW, Ge JJ. Thoracoscope-assisted Right Vertical Infra-axillary Mini-incision for Cardiac Surgery. Heart Lung Circ 2015; 24:590-4. [DOI: 10.1016/j.hlc.2014.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Xu M, Zhu S, Wang X, Huang H, Zhao J. Two Different Minimally Invasive Techniques for Female Patients with Atrial Septal Defects: Totally Thoracoscopic Technique and Right Anterolateral Thoracotomy Technique. Ann Thorac Cardiovasc Surg 2015; 21:459-65. [PMID: 26004113 DOI: 10.5761/atcs.oa.15-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To compare the outcomes of totally thoracoscopic technique (TTS) vs. right anterolateral thoracotomy technique (RALT) in female patients undergoing minimal invasive atrial septal defect (ASD) correction. METHODS From March 2011 to January 2013, 125 female patients underwent minimally invasive atrial septal defect closure, of whom 62 patients were in the TTS group and 63 were in the RALT group. RESULTS Procedures were performed successfully in all patients without in-hospital mortality or major complications. cardiopulmonary bypass (CPB) time were 48.95 ± 15.63 min in TTS group, 31.4 ± 8.04 min in RALT group (p <0.001); the cross-clamp time were 26.92 ± 11.84 min in TTS group and 18.51 ± 6.11 min in RALT group (p <0.001). The length of incision in RALT group (6.02 ± 1.03 cm) was longer than TTS group (5.31 ± 0.68 cm) and the difference was significant (p <0.001). The overall satisfaction rate for the cosmetic results of TTS was 100% and was 96.83% (61/63 patients) in RALT patients. During follow-up, all patients in TTS group were satisfied expect two patients complained that scar was too long at groin. Reasons for a lower score in RALT group included the long scar in the chest; a RALT incision that was located too medially (coming off the bra line) and asymmetrical breast development. CONCLUSIONS Both TTS and RALT are valid and reliable cosmetic surgical techniques for repairing ASDs in female patients. Both techniques allow excellent cosmetic and functional results in most female patients. The totally thoracoscopic technique may gain shorter incision and cosmetic results compared with RALT.
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Affiliation(s)
- Ming Xu
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R.China
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Sabate Rotes A, Burkhart HM, Suri RM, Grogan M, Taggart NW, Li Z, Schaff HV, Dearani JA. Minimally invasive video-assisted surgical closure of atrial septal defects: a safe approach. World J Pediatr Congenit Heart Surg 2015; 5:527-33. [PMID: 25324249 DOI: 10.1177/2150135114542166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of video-assisted thoracic surgery (VATS) versus conventional median sternotomy (open) in the repair of secundum atrial septal defect (ASD) or patent foramen ovale (PFO). DESIGN Among 415 consecutive patients undergoing open or VATS ASD/PFO closure between 1993 and October 2012, 153 patients were compared using 2:1 frequency matching (n=102 open vs 51 VATS). Matching variables include age, gender, body surface area, past medical history of neurologic events, and need of patch closure. Median age was 43 years (3-71 years), and 67% were female. RESULTS There were no early deaths in either group. There were no conversions to open sternotomy. Although mean cross-clamp time (14.5±7.6 vs 26.3±13.2 minutes, P<.001) and bypass time (31.7±13.8 vs 60.9±20.9 minutes, P<.001) were longer in the VATS group, patients who underwent VATS had shorter postoperative ventilation time (7.5±6.4 vs 4.4±2.8 hours, P=.03) with 62.7% extubated in the operating room, along with shorter intensive care unit stay (26.7±10.8 vs 19.1±9.9 hours, P<.001) and hospital stay (5.2±1.9 vs 3.5±0.9 days, P<.001). At early follow-up (mean 1.5 years, maximum 4.2 years), there was no difference in need for reintervention. Of the 27 patients who underwent VATS ASD/PFO closure for a neurologic event, none had a recurrence. CONCLUSION The use of VATS provides a safe, equally effective alternative to conventional sternotomy for ASD/PFO closure, using a less invasive approach.
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Affiliation(s)
| | | | - Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Martha Grogan
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Arora KS, Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K. Learning curves for cardiothoracic and vascular surgical procedures--a systematic review. Postgrad Med 2014; 127:202-14. [PMID: 25529043 DOI: 10.1080/00325481.2014.996113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this systematic review is to evaluate the learning curve (LC) literature and identify the LC of cardiothoracic and vascular surgical procedures. SUMMARY AND BACKGROUND The LC describes an observation that a learner's performance improves over time during acquisition of new motor skills. Measuring the LC of surgical procedures has important implications for surgical innovation, education, and patient safety. Numerous studies have investigated LCs of isolated operations in cardiothoracic and vascular surgeries, but a lack of uniformity in the methods and variables used to measure LCs has led to a lack of systematic reviews. METHODS The MEDLINE®, EMBASE™, and PsycINFO® databases were systematically searched until July 2013. Articles describing LCs for cardiothoracic and vascular procedures were included. The type of procedure, statistical analysis, number of participants, procedure setting, level of participants, outcomes, and LCs were reviewed. RESULTS A total of 48 studies investigated LCs in cardiothoracic and vascular surgeries. Based on operating time, the LC for coronary artery bypass surgery ranged between 15 and 100 cases; for endoscopic vessel harvesting and other cardiac vessel surgery between 7 and 35 cases; for valvular surgery, which included repair and replacement, between 20 and 135 cases; for video-assisted thoracoscopic surgery, between 15 and 35 cases; for vascular neurosurgical procedures between 100 and 500 cases, based on complications; for endovascular vessel repairs between 5 and 40 cases; and for ablation procedures between 25 and 60 cases. However there was a distinct lack of standardization in the variables/outcome measures used, case selection, prior experience, and supervision of participating surgeons and a range of statistical analyses to compute LCs was noted. CONCLUSION LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.
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Affiliation(s)
- Karan Singh Arora
- Department of Urology, King's Health Partners, MRC Centre for Transplantation, King's College London, Guy's Hospital , St Thomas Street, London , UK
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Retraction notice to: Long-term assay of off-pump atrial septal defect closure using vena caval inflow occlusion and minimally invasive approaches in 130 cases. Eur J Cardiothorac Surg 2014; 47:1114. [PMID: 25326016 DOI: 10.1093/ejcts/ezu405] [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] [Indexed: 11/13/2022] Open
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Xiao C, Gao C, Yang M, Wang G, Wu Y, Wang J, Wang R, Yao M. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg 2014; 19:933-7. [DOI: 10.1093/icvts/ivu263] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lewis CT, Bethencourt DM, Stephens RL, Cline JL, Tyndal CM. Robotic Repair of Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Return and Persistent Left Superior Vena Cava. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Clifton T.P. Lewis
- Division of Cardiothoracic Surgery Princeton Baptist Medical Center, Birmingham, AL USA
| | - Daniel M. Bethencourt
- Division of Cardiothoracic Surgery, Long Beach Memorial Medical Center, Long Beach, CA USA
| | - Richard L. Stephens
- Division of Cardiothoracic Surgery Princeton Baptist Medical Center, Birmingham, AL USA
| | - Jennifer L. Cline
- Sarasota Memorial Hospital, FL USA
- Sarasota Vascular Specialists, Sarasota, FL USA
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Senay S, Gullu AU, Kocyigit M, Degirmencioglu A, Karabulut H, Alhan C. Robotic atrial septal defect closure. Multimed Man Cardiothorac Surg 2014; 2014:mmu014. [PMID: 25107453 DOI: 10.1093/mmcts/mmu014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Atrial septal defect (ASD) is one of the most common congenital cardiac diseases. This pathology can be treated with percutaneous devices. However, some of the ASDs are not suitable for device closure. Also, there may be device-related late complications of transcatheter ASD closure. Currently, robotic surgical techniques allow surgeons to close ASDs in a totally endoscopic fashion with a high success rate and a low complication rate. This study demonstrates the basic concepts and technique of robotic ASD closure.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology and Reanimation, Acıbadem University Vocational Schools, Istanbul, Turkey
| | - Aleks Degirmencioglu
- Department of Cardiology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
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Wehman B, Lehr EJ, Lahiji K, Lee JD, Kon ZN, Jeudy J, Griffith BP, Bonatti J. Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 2014; 19:572-6. [DOI: 10.1093/icvts/ivu226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weisz G, Smilowitz NR, Metzger DC, Caputo R, Delgado J, Marshall JJ, Vetrovec G, Reisman M, Waksman R, Pichard A, Granada JF, Moses JW, Carrozza JP. The association between experience and proficiency with robotic-enhanced coronary intervention—insights from the PRECISE multi-center study. ACTA ACUST UNITED AC 2014; 16:37-40. [DOI: 10.3109/17482941.2014.889314] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ma ZS, Yang CY, Dong MF, Wu SM, Wang LX. Totally thoracoscopic closure of ventricular septal defect without a robotically assisted surgical system: a summary of 119 cases. J Thorac Cardiovasc Surg 2013; 147:863-7. [PMID: 24315697 DOI: 10.1016/j.jtcvs.2013.10.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/31/2013] [Accepted: 10/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To summarize the clinical outcomes of totally thoracoscopic closure of a ventricular septal defect (VSD). METHODS Totally thoracoscopic VSD closure was performed in 119 patients (66 boys; mean age, 7.1 ± 3.6 years). An additional 35 patients undergoing open-chest VSD closure were selected as a control group. Using 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and VSD closure were performed by thoracoscopy without the aid of a robotically assisted surgical system. RESULTS Cardiopulmonary bypass and aortic crossclamp times were 42.2 ± 9.8 and 32.5 ± 7.3 minutes, respectively. There were no deaths but 1 patient required insertion of a permanent pacemaker as a result of postoperative atrioventricular conduction block. The length of stay in the intensive care unit (11.0 ± 2.6 vs 22.9 ± 4.9 hours, P < .01) or postoperative hospital stay (4.2 ± 1.1 vs 6.6 ± 2.1 days, P < .03) in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (31.9% vs 74.2%, P < .001). Rate of blood transfusion during the operation (17.6% vs 65.7%, P = .001) and the postoperative use of opioid analgesics (31.9% vs 74.3%, P = .003) in the thoracoscopic group was lower than in the control group. Transesophageal echocardiographic analysis 4.6 ± 2.3 months after the operation showed complete closure of the defect. CONCLUSIONS Totally thoracoscopic closure of VSD through a 3-port entry was safe and effective.
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Affiliation(s)
- Zeng-Shan Ma
- Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China.
| | - Chang-Yong Yang
- Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Ming-Feng Dong
- Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China
| | - Shu-Ming Wu
- Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Le-Xin Wang
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China.
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Abstract
Robotic cardiac operations evolved from minimally invasive operations and offer similar theoretical benefits, including less pain, shorter length of stay, improved cosmesis, and quicker return to preoperative level of functional activity. The additional benefits offered by robotic surgical systems include improved dexterity and degrees of freedom, tremor-free movements, ambidexterity, and the avoidance of the fulcrum effect that is intrinsic when using long-shaft endoscopic instruments. Also, optics and operative visualization are vastly improved compared with direct vision and traditional videoscopes. Robotic systems have been utilized successfully to perform complex mitral valve repairs, coronary revascularization, atrial fibrillation ablation, intracardiac tumor resections, atrial septal defect closures, and left ventricular lead implantation. The history and evolution of these procedures, as well as the present status and future directions of robotic cardiac surgery, are presented in this review.
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Affiliation(s)
- Bryan Bush
- Division of Cardiothoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA
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Yao DK, Chen H, Ma LL, Ma ZS, Wang LX. Totally Endoscopic Atrial Septal Repair with or without Robotic Assistance: A Systematic Review and Meta-analysis of Case Series. Heart Lung Circ 2013; 22:433-40. [DOI: 10.1016/j.hlc.2012.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/25/2012] [Accepted: 12/28/2012] [Indexed: 02/07/2023]
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Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system. J Cardiothorac Surg 2013; 8:119. [PMID: 23634811 PMCID: PMC3652753 DOI: 10.1186/1749-8090-8-119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More and more surgeons and patients focus on the minimally invasive surgical techniques in the 21st century. Totally thoracoscopic operation provides another minimal invasive surgical option for patients with ASD (atrial septal defect). In this study, we reported our experience of 61 patients with atrial septal defect who underwent totally thoracoscopic operation and discussed the feasibility and safety of the new technique. METHODS From January 2010 to October 2012, 61 patients with atrial septal defect underwent totally thoracoscopic closure but not traditional median sternotomy surgery. We divided the 61 patients into two groups based on the operation sequence. The data of group A (the first 30 cases) and group B (the last 31 cases). The mean age of the patients was 35.1 ± 12.8 years (range, 6.3 to 63.5 years), and mean weight was 52.7 ± 11.9 kg (range, 30.5 to 80 kg). Mean size of the atrial septal defect was 16.8 ± 11.3 mm (range, 13 to 39 mm) based on the description of the echocardiography. RESULTS All patients underwent totally thoracoscopy successfully, 36 patients with pericardium patch and 25 patients were sutured directly. 7 patients underwent concomitant tricuspid valvuloplasty with Key technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 68.5 ± 19.1 min (range, 31.0 to 153.0 min), the mean time of aortic cross-clamp was 27.2 ± 11.3 min (range, 0.0 to 80.0 min) and the mean time of operation was 149.8 ± 35.7 min (range, 63.0 to 300.0 min). Postoperative mechanical ventilation averaged 4.9 ± 2.5 hours (range, 3.5 to 12.6 hours), and the duration of intensive care unit stay 20.0 ± 4.8 hours (range, 15.5 to 25 hours). The mean volume of blood drainage was 158 ± 38 ml (range, 51 to 800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at 3-month follow-up. CONCLUSION The totally thoracoscopic operation is feasible and safe for patients with ASD, even with or without tricuspid regurgitation. This technique provides another minimal invasive surgical option for patients with atrial septal defect.
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