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Rusch M, Hoffmann G, Wieker H, Bürger M, Kapahnke S, Berndt R, Rusch R. Evaluation of the MMI Symani ® robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model. J Robot Surg 2024; 18:168. [PMID: 38598047 PMCID: PMC11006781 DOI: 10.1007/s11701-024-01921-x] [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] [Received: 02/09/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
The MMI Symani® is a recently approved robotic microsurgical system for surgical procedures in adults. The system enables the surgeon to create microanastomoses. Clinical applications so far include lymphatic vessels surgery and the creation of special flap plastics. The use of the system in coronary arteries has not yet been assessed. The aim of this preclinical study was to evaluate the applicability of the Symani® surgical system in the creation of coronary anastomoses a cadaveric porcine model. A total of 12 anastomoses were performed by three senior cardiovascular surgeons on the left main coronary artery of three porcine hearts. Artificial bypasses (diameter 1 mm) were performed to the left main trunk. The anastomoses were performed with the Symani® surgical system. Evaluation included procedure times and anastomosis leakage. All anastomoses could be successfully performed. The procedure time decreased due to the learning curve between the first anastomosis 47:28 ± 5:30 min and the last anastomosis 22:37 ± 3:25 min. The final evaluation of the anastomoses showed excellent results with low leakage. The quality of the anastomosis also improved in relation to the increasing learning curve. The Symani® surgical system could be used to create coronary anastomoses in an acceptable time frame and without technical failures. Hence, the system appears feasible for conventional coronary surgery. Further studies in animal models are mandatory prior to clinical application.
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Affiliation(s)
- Melanie Rusch
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - Grischa Hoffmann
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - Henning Wieker
- Clinic of Cranio-Maxillo-Facial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - Matthias Bürger
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - Sebastian Kapahnke
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - Rouven Berndt
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany
| | - René Rusch
- Clinic of Vascular and Endovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Hs C, D-24105, Kiel, Germany.
- Kurt-Semm-Center for Laparoscopic and Robotic-Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, 24105, Kiel, Germany.
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2
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Badhwar V, Pereda D, Khaliel FH, Poffo R, Darehzereshki A, Mehaffey JH, Yan TD, Melnitchouk S, Geirsson A, Arghami A, Navia JL, Raikar GV, Weber AC, Ramzy D, Černý Š, Vojáček J, Smith RL, Bonatti J, Thourani VH, Wei LM. Outcomes following initial multicenter experience with robotic aortic valve replacement: Defining a path forward. J Thorac Cardiovasc Surg 2024; 167:1244-1250. [PMID: 38246340 DOI: 10.1016/j.jtcvs.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Feras H Khaliel
- Division of Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Robinson Poffo
- Department of Cardiovascular Surgery, Hospital Moriah, Sao Paulo, Brazil
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Arnar Geirsson
- Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jose L Navia
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, Fla
| | - Goya V Raikar
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Pleasant Prairie, Wis
| | - Alberto C Weber
- Department of Cardiovascular Surgery, Herzzentrum Hislanden, Zurich, Switzerland
| | - Danny Ramzy
- Division of Cardiac Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Štěpán Černý
- Department of Cardiac Surgery, University Hospital Motol, Prague, Czech Republic
| | - Jan Vojáček
- Department of Cardiac Surgery, University Hospital, Hradec Kralove, Czech Republic
| | - Robert L Smith
- Division of Cardiac Surgery, Baylor Scott & White Health, Plano, Tex
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Vinod H Thourani
- Department of Cardiothoracic Surgery, Piedmont Healthcare, Atlanta, Ga
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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3
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Atroshchenko GV, Navarra E, Valdis M, Sandoval E, Hashemi N, Cerny S, Pereda D, Palmen M, Bjerrum F, Bruun NH, Tolsgaard MG. Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trial. JTCVS OPEN 2023; 16:619-627. [PMID: 38204726 PMCID: PMC10775167 DOI: 10.1016/j.xjon.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 01/12/2024]
Abstract
Objective This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Methods We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. Results The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. Conclusions The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. Clinical trial registry number NCT05043064.
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Affiliation(s)
- Gennady V. Atroshchenko
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- ROCnord Robotic Centre Aalborg, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emiliano Navarra
- Department of Cardiac Surgery, Ospedale Sant'Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Matthew Valdis
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Nasseh Hashemi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Nordsim, Aalborg University Hospital, Aalborg, Denmark
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Flemming Bjerrum
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Denmark
- Department of Medicine, University of Copenhagen, Denmark
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Darehzereshki A, Wei LM, Comas G, Mehaffey JH, Badhwar V. Feasibility and safety of robotic aortic root enlargement in conjunction with robotic aortic valve replacement. JTCVS Tech 2023; 22:178-180. [PMID: 38152207 PMCID: PMC10750884 DOI: 10.1016/j.xjtc.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Lawrence M. Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - George Comas
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J. Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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5
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Hosoba S, Ito T, Mori M, Kato R, Kajiyama K, Maeda S, Nakai Y, Morishita Y. Endoscopic Aortic Valve Replacement: Initial Outcomes of Isolated and Concomitant Surgery. Ann Thorac Surg 2023; 116:744-749. [PMID: 37276923 DOI: 10.1016/j.athoracsur.2023.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The applicability of totally endoscopic surgical aortic valve replacement (AVR) in multivalve operations is unknown. This study describes an approach and perioperative outcomes of totally endoscopic isolated and concomitant AVR using various valve types. METHODS A total of 216 patients (114 male; mean age, 71.3 ± 11.3 years) underwent totally endoscopic AVR from May 2017 to October 2022 in a tertiary care center. The 3-port technique was used: a 3- to 4-cm main port without rib spreading, a 10-mm 3-dimensional endoscopic port, and a 5-mm left-hand port with femoral cannulations. Sutures were hand tied with a knot pusher. Descriptive analyses compared perioperative outcomes between patients with or without concomitant procedures. RESULTS Of 216 patients, concomitant surgery was performed in 33 (15.2%) patients. Of the 33, 21 (63.6%) had a concomitant mitral procedure. A stented bioprosthesis was implanted in 165 (76.3%) patients, a mechanical valve in 22 (10.2%) patients, and a rapid deployment or sutureless valve in 29 (13.4%) patients. Median operation time and aortic cross-clamp time were 175 minutes (interquartile range; 150-194 minutes) and 78 minutes (interquartile range; 67-92 minutes) for isolated AVR, respectively. Thirty-day mortality occurred in 1 patient (0.5%). Two patients (0.9%) had conversion to sternotomy. Major neurologic events occurred in 3 patients (1.4%). The major adverse event rate was similar between patients with or without concomitant procedures. CONCLUSIONS Endoscopic AVR can safely address concomitant valve diseases.
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Affiliation(s)
- Soh Hosoba
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Makoto Mori
- Division of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Riku Kato
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koh Kajiyama
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Shogo Maeda
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Nakai
- Department of Clinical Engineering, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
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6
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Wei LM, Darehzereshki A, Comas GM, Mehaffey JH, Rankin JS, Badhwar V. Robotic-assisted repair of aortic valve leaflet prolapse by cusp plication and annuloplasty. JTCVS Tech 2023; 21:59-61. [PMID: 37854840 PMCID: PMC10580170 DOI: 10.1016/j.xjtc.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Lawrence M. Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - George M. Comas
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J. Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J. Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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Koulaouzidis G, Charisopoulou D, Bomba P, Stachura J, Gasior P, Harpula J, Zarifis J, Marlicz W, Hudziak D, Jadczyk T. Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:399. [PMID: 37754828 PMCID: PMC10532157 DOI: 10.3390/jcdd10090399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Dafni Charisopoulou
- Pediatric Cardiology Department, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | | | | | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - Jan Harpula
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - John Zarifis
- Cardiology Department, George Papanikolaou General Hospital, 570 10 Thessaloniki, Greece;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic
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8
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Ishikawa N, Watanabe G, Koakutsu T, Horikawa T, Seguchi R, Tomita S, Ohtsuka T. Robotic Surgery for Triple Valve Insufficiency: A Case Report. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:380-383. [PMID: 37534405 DOI: 10.1177/15569845231185394] [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: 08/04/2023]
Abstract
A 63-year-old woman was referred to our institution for surgical treatment of triple valve (aortic, mitral, and tricuspid) insufficiency and underwent a robot-assisted endoscopic procedure. Three intercostal ports were placed in the right lateral chest for robotic instruments and a retrograde cardioplegic cannula, and a 5 cm thoracotomy was made for the procedure, which was a mitral valve repair with neochords and ring annuloplasty, an aortic valve replacement with bioprosthetic valve, and a ring tricuspid annuloplasty. Surgery was successfully achieved without blood transfusion or any complications.
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Affiliation(s)
- Norihiko Ishikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toru Koakutsu
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Takafumi Horikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ryuta Seguchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toshiya Ohtsuka
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
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9
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Kirmani BH, Akowuah E. Minimal Access Aortic Valve Surgery. J Cardiovasc Dev Dis 2023; 10:281. [PMID: 37504537 PMCID: PMC10380690 DOI: 10.3390/jcdd10070281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Minimally invasive approaches to the aortic valve have been described since 1993, with great hopes that they would become universal and facilitate day-case cardiac surgery. The literature has shown that these procedures can be undertaken with equivalent mortality rates, similar operative times, comparable costs, and some benefits regarding hospital length of stay. The competing efforts of transcatheter aortic valve implantation for these same outcomes have provided an excellent range of treatment options for patients from cardiology teams. We describe the current state of the art, including technical considerations, caveats, and complications of minimal access aortic surgery and predict future directions in this space.
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Affiliation(s)
- Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Enoch Akowuah
- Cardiac Surgery, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK
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10
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Yoshikawa Y, Kishimoto Y, Onohara T, Kumagai K, Nii R, Sumi N, Kishimoto N, Ikeda Y, Yoshikawa Y, Yamane K, Nishimura M. Robot-Assisted Aortic Valve Replacement - First Clinical Report in Japan. Circ J 2023; 87:847-851. [PMID: 37062718 DOI: 10.1253/circj.cj-23-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Robot-assisted valve surgery represents the latest development in the field of minimally invasive approaches. Robotic assistance may provide greater visualization, enhanced dexterity, and greater precision than traditional mini-thoracotomy aortic valve replacement.Methods and Results: Aortic valve replacement operations using the da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) were performed on 2 patients, 1 with severe aortic insufficiency and the other with aortic stenosis. Both patients had an uneventful postoperative course and were discharged without any adverse events. CONCLUSIONS Robot-assisted assisted aortic valve replacement appears feasible and safe in limited cases.
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Affiliation(s)
- Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Naoki Sumi
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Nozomi Kishimoto
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yosuke Ikeda
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yuki Yoshikawa
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Kazuma Yamane
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
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11
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Badhwar V, Wei LM, Geirsson A, Dearani JA, Grossi EA, Guy TS, Balkhy HH, Gillnov AM, Sutter FP, Melnitchouk S, Bonatti J, Murphy DA, Chitwood WR. Contemporary robotic cardiac surgical training. J Thorac Cardiovasc Surg 2023; 165:779-783. [PMID: 34862051 DOI: 10.1016/j.jtcvs.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/16/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale-New Haven Health System, New Haven, Conn
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University, New York, NY
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Husam H Balkhy
- Division of Cardiac Surgery, University of Chicago, Chicago, Ill
| | - A Marc Gillnov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Francis P Sutter
- Department of Cardiothoracic Surgery, Main Line Health Lankenau Medical Center, Wynnewood, Pa
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Mass
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | | | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
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12
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Wei LM, Badhwar V. The Patient, Only and Always. Ann Thorac Surg 2022; 114:1976-1977. [PMID: 34942186 DOI: 10.1016/j.athoracsur.2021.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506.
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Wong DH, Yost CC, Rosen JL, Wu M, Guy TS. Totally Endoscopic Robot-Assisted Aortic Valve Replacement and Complex Mitral Valve Repair: The Lateral Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:355-357. [PMID: 35770552 DOI: 10.1177/15569845221106939] [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
A 76-year-old male patient was referred to our institution with moderate-to-severe aortic and mitral insufficiency. The patient underwent totally endoscopic robot-assisted aortic valve replacement and mitral valve repair. In this article, we present our lateral approach to the robotic double valve surgery.
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Affiliation(s)
- Daniella H Wong
- 12313Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Colin C Yost
- 12313Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Jake L Rosen
- 12313Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Meagan Wu
- 12313Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Department of Surgery, 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
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14
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Almousa A, Mehaffey JH, Wei LM, Simsa A, Hayanga JA, Cook C, Rankin JS, Badhwar V. Robotic-assisted Cryothermic Cox Maze for Persistent Atrial Fibrillation: Longitudinal Follow-up. J Thorac Cardiovasc Surg 2022; 165:1828-1836.e1. [PMID: 36028363 DOI: 10.1016/j.jtcvs.2022.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Surgical ablation of atrial fibrillation (AF) is recommended as a stand-alone therapy for patients refractory to medical or catheter-based treatment, or as a concomitant therapy when associated with structural disease. We report a single-therapy robotic approach to the Cox maze with longitudinal follow-up. METHODS Consecutive patients who underwent robotic biatrial cryothermic Cox maze for nonparoxysmal AF between November 2016 and January 2022 were examined at 1, 2, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months. Freedom from atrial tachyarrhythmia was assessed with 24-hour continuous electrocardiogram or pacemaker interrogation in all patients after 6 months. Mean follow-up was 17 ± 14.5 months (range, 1-60 months). Time to event analysis with competing risks was used to determine risk-adjusted associations with late outcomes. RESULTS Patients (n = 135) had a median AF duration of 4.0 years (interquartile range, 0.8-7.0), with 29.6% in whom 1 or more catheter ablations had failed. Stand-alone maze was performed in 25.2%, whereas 61.4% underwent concomitant robotic mitral valve surgery, 7.4% tricuspid valve repair, and 4.4% aortic valve replacement. No patients were discharged in AF. There were 3 operative mortalities (2.2%), none in stand-alone patients. One patient required catheter ablation at 8 months postoperatively, and one had a nonembolic stroke at 18 months. There were 9 late deaths. Freedom from atrial tachyarrhythmia and antiarrhythmic drugs at 9, 12, 18, 24, 36, and 48 months was 97.0%, 96.7%, 98.1%, 97.1%, and 100%, respectively. Lower ejection fraction and need for concomitant mitral valve replacement and/or aortic valve replacement were independently associated with worse survival. CONCLUSIONS For persistent AF, robotic biatrial cryothermic Cox maze offered greater than 90% 1-year longitudinal freedom from stroke, oral anticoagulation, repeat ablation, and recurrent AF without the need for antiarrhythmic drugs.
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Wei LM, Cook CC, Hayanga JWA, Rankin JS, Mascio CE, Badhwar V. Robotic Aortic Valve Replacement: First 50 Cases. Ann Thorac Surg 2021; 114:720-726. [PMID: 34560044 DOI: 10.1016/j.athoracsur.2021.08.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/03/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Existing management challenges in selecting transcatheter versus surgical aortic valve replacement (SAVR) include bicuspid stenosis, low clinical risk, horizontal valve position, aortic insufficiency (AI), and need for concomitant procedures or mechanical valves. To address these gaps, we present our early experience with fully robotic-assisted aortic valve replacement (RAVR). METHODS Between January 2020 and February 2021, 50 consecutive RAVR operations were performed utilizing a 3-4 cm lateral mini-thoracotomy three-port technique with transthoracic aortic clamping, similar to our robotic mitral platform. Conventional SAVR prostheses were implanted with interrupted braided sutures in all cases. RESULTS Median age was 67.5 years, BMI was 29, calcified bicuspid disease was present in 28/50 (56%), and severe AI in 8/50 (16%). Ejection fraction was 54.8±8.4% (mean±SD), and STS PROM was 1.54±0.7%. Mechanical prostheses were used in 16/50 (32%), and 7 required concomitant procedures including Cox-Maze (3), left atrial appendage clipping (1), aortic root enlargement (2), mitral repair (1), and left atrial myxoma excision (1). Median times for cardiopulmonary bypass, cross-clamp, valvectomy, annular sutures, and aortotomy closure were 166, 117, 4, 20, and 31 minutes, respectively. All times plateaued after the initial five cases. Most patients (42/50, 84%) were extubated in the operating room, and the remainder (8/50, 16%) within 4 hours. There was no 30-day operative mortality or stroke. All had 30-day echocardiography demonstrating no valvular or perivalvular abnormalities. CONCLUSIONS RAVR appears to have procedural safety and short-term outcomes to rival alternatives. Incremental experience may facilitate the safe performance of concomitant procedures as deemed necessary.
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Affiliation(s)
- Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chris C Cook
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Christopher E Mascio
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV.
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16
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Cocchieri R, van de Wetering B, Stijnen M, Riezebos R, de Mol B. The Impact of Biomedical Engineering on the Development of Minimally Invasive Cardio-Thoracic Surgery. J Clin Med 2021; 10:jcm10173877. [PMID: 34501325 PMCID: PMC8432110 DOI: 10.3390/jcm10173877] [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] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) We describe the boundary conditions for minimally invasive cardiac surgery (MICS) with the aim to reduce procedure-related patient injury and discomfort. (2) The analysis of the MICS work process and its demand for improved tools and devices is followed by a description of the relevant sub-specialties of bio-medical engineering: electronics, biomechanics, and materials sciences. (3) Innovations can represent a desired adaptation of an existing work process or a radical redesign of procedure and devices such as in transcutaneous procedures. Focused interaction between engineers, industry, and surgeons is always mandatory (i.e., a therapeutic alliance for addressing 'unmet patient or professional needs'. (4) Novel techniques in MICS lean heavily on usability and safe and effective use in dedicated hands. Therefore, the use of training and simulation models should enable skills selection, a safe learning curve, and maintenance of proficiency. (5) The critical technical steps and cost-benefit trade-offs during the journey from invention to application will be explained. Business considerations such as time-to-market and returns on investment do shape the cost-benefit room for commercial use of technology. Proof of clinical safety and effectiveness by physicians remains important, but establishing the technical reliability of MICS tools and warranting appropriate surgical skills come first.
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Affiliation(s)
- Riccardo Cocchieri
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bertus van de Wetering
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Marco Stijnen
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Robert Riezebos
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bastian de Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
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17
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Amabile A, Komlo CM, Sloane Guy T. Showcasing the lateral approach for robotic aortic and mitral valve surgery: Does one approach fit it all? J Card Surg 2021; 36:3860-3861. [PMID: 34189761 DOI: 10.1111/jocs.15782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline M Komlo
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas Sloane Guy
- Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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18
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Sandoval E, Fernández-Cisneros A, García TA, Pereda D. Robotic resection of an aortic valve fibroelastoma using a right lateral approach. J Card Surg 2021; 36:3857-3859. [PMID: 34189768 DOI: 10.1111/jocs.15781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Robotic technology provides excellent visualization and surgical precision and it is reaching maturity in cardiac surgery, although mostly confined to mitral surgery and coronary revascularization. Robotic aortic valve surgery (rAVS) has not been sufficiently developed, and experience is extremely scarce. METHODS We present a robotic resection of a papillary fibroelastoma on the aortic valve using a totally thoracoscopic right lateral approach. RESULTS This technique provides excellent exposure, facilitates patient recovery and improves cosmesis. CONCLUSIONS rAVS has tremendous potential and many patients may benefit in the future. The lateral approach used in our case may offers advantages over others previously attempted and may also facilitate adoption of rAVS by teams currently performing robotic mitral surgery.
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Affiliation(s)
- Elena Sandoval
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | | | - Tito A García
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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19
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Badhwar V, Smith CR, Woo J. Expert contributions enhance knowledge of valvular heart disease. J Thorac Cardiovasc Surg 2021; 162:86-89. [PMID: 33985813 DOI: 10.1016/j.jtcvs.2021.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Craig R Smith
- Department of Surgery, Columbia University, New York, NY
| | - Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
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20
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Edelman JJ, Thourani VH. Commentary: Robotic aortic valve replacement-fad or future? J Thorac Cardiovasc Surg 2021; 161:1763-1764. [PMID: 33461816 DOI: 10.1016/j.jtcvs.2020.11.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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21
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Komlo CM, Guy TS. Commentary: Robotic surgical aortic valve replacement: An evolving option. J Thorac Cardiovasc Surg 2020; 161:1762-1763. [PMID: 33451828 DOI: 10.1016/j.jtcvs.2020.11.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline M Komlo
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - T Sloane Guy
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa.
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22
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Wyler von Ballmoos MC, Reardon MJ. Commentary: The laws of robotics. J Thorac Cardiovasc Surg 2020; 161:1760-1761. [PMID: 33288237 DOI: 10.1016/j.jtcvs.2020.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex.
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