The janus syndrome: a perspective on a new era of computer-enhanced robotic cardiac surgery

Optimal port placement and enhanced guidance in robotically assisted cardiac surgery

BACKGROUND

Optimal port placement and enhanced guidance in robotically assisted cardiac surgery is required to improve preoperative planning and intraoperative navigation.

METHODS

Offline optimal port placement is planned on a three-dimensional virtual reconstruction of the patient's computed tomography scan. Using this data, an accurate in vivo port placement can be performed, which is achieved by augmented reality techniques superimposing virtual models of the thorax and the teleoperator arms on top of the real worldview.

RESULTS

A new system incorporating both port placement planning and intraoperative navigation in robotically assisted minimally invasive heart surgery was established to aid the operative workflow. A significant reduction of operation time by improved planning and intraoperative support is anticipated.

CONCLUSIONS

The enhanced intraoperative orientation possibilities may lead to further decrease in operation time and have the continuing ability to improve quality.

Results of a phase one study on robotically assisted myocardial revascularization on the beating heart

BACKGROUND

The objective of this study was to evaluate the feasibility of computer assisted myocardial revascularization on the beating heart.

METHODS

Ten patients underwent at least one robotically assisted internal mammary artery (IMA) anastomosis utilizing the da Vinci surgical system (Intuitive Surgical, Inc, Mountain View, CA) performed through an open incision as part of standard multivessel off pump revascularization. Following chest closure a selective IMA angiogram was performed to assess patency. Three month follow-up included a stress echocardiogram.

RESULTS

There were 12 anastomoses performed in 10 patients. The average age was 61 years with a mean ejection fraction of 56%. No patient required inotropic support. Eight of 10 patients were found to have fully patent IMA anastomoses by angiogram. One patient was noted to have an occluded left anterior descending coronary artery distal to the anastomosis and one had occlusion at the anastomosis. Both patients had immediate manual revision of the anastomosis. One patient who required anastomotic revision experienced postoperative myocardial infarction and sternal wound infection requiring pectoralis flaps.

CONCLUSIONS

Because robotic instrumentation is meant for closed chest procedures, there were major issues with positioning of the robotic arms in this study since the chest was open. Although two patients required anastomotic revision, there were no complications or technical failures related to the robotic system. Thus, based upon this study robotically assisted beating heart revascularization appears to be feasible, safe, and effective. Further evaluation will be necessary to determine the role of robotically assisted totally endoscopic coronary artery bypass on the beating heart in the United States.