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Hamilton J, Caridi-Scheible M. Anesthetic Management for Minimally Invasive Cardiac Surgery. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.
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Affiliation(s)
- Wendy K Bernstein
- Department of Anesthesiology, University of Maryland School of Medicine, USA
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Mandal K, Alwair H, Nifong WL, Chitwood WR. Robotically assisted minimally invasive mitral valve surgery. J Thorac Dis 2014; 5 Suppl 6:S694-703. [PMID: 24251030 DOI: 10.3978/j.issn.2072-1439.2013.11.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 11/14/2022]
Abstract
Increased recognition of advantages, over the last decade, of minimizing surgical trauma by operating through smaller incisions and its direct impact on reduced postoperative pain, quicker recovery, improved cosmesis and earlier return to work has spurred the minimally invasive cardiac surgical revolution. This transition began in the early 1990s with advancements in endoscopic instruments, video & fiberoptic technology and improvements in perfusion systems for establishing cardiopulmonary bypass (CPB) via peripheral cannulation. Society of Thoracic Surgeons data documents that 20% of all mitral valve surgeries are performed using minimally invasive techniques, with half being robotically assisted. This article reviews the current status of robotically assisted mitral valve surgery, its advantages and technical modifications for optimizing clinical outcomes.
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Affiliation(s)
- Kaushik Mandal
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA; ; Department of Cardiovascular Surgery, East Carolina Heart Institute at East Carolina University, Greenville NC 27834, USA
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Abstract
The transition of mitral valve surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve. The use of telemanipulative robotic arms with near 3-dimensional valve visualization has allowed for near complete endoscopic robotic-assisted mitral valve surgery, providing increased patient satisfaction and cosmesis. Studies have shown rapid recovery times without sacrificing perioperative safety or the durability of surgical repair. Although a steep learning curve exists as well as high fixed and disposable costs, continued technological development fueled by increasing patient demand may allow for further expansion in the use of robotic-assisted minimal invasive surgery.
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Affiliation(s)
- William Vernick
- Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University Hosptial of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Deshpande SP, Lehr E, Odonkor P, Bonatti JO, Kalangie M, Zimrin DA, Grigore AM. Anesthetic Management of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Surgery (TECAB). J Cardiothorac Vasc Anesth 2013; 27:586-99. [DOI: 10.1053/j.jvca.2013.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 11/11/2022]
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Wang G, Gao C, Zhou Q, Chen T, Wang Y, Wang J, Li J. Anesthesia management of totally endoscopic atrial septal defect repair with a robotic surgical system. J Clin Anesth 2012; 23:621-5. [PMID: 22137513 DOI: 10.1016/j.jclinane.2011.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 03/22/2011] [Accepted: 04/20/2011] [Indexed: 10/14/2022]
Abstract
STUDY OBJECTIVE To investigate anesthetic techniques for robot-assisted endoscopic atrial septal defect (ASD) repair. DESIGN Clinical observational study. SETTING Operating room of a general military hospital. PATIENTS 56 adult, ASA physical status 1 and 2 patients undergoing elective general anesthesia. INTERVENTIONS After induction of general anesthesia, a left-sided, double-lumen endotracheal tube was positioned to allow single left-lung ventilation and contralateral CO(2) pneumothorax (capnothorax). With ultrasound guidance, peripheral cardiopulmonary bypass (CPB) catheters were placed. MEASUREMENTS AND MAIN RESULTS All patients tolerated single left-lung ventilation before CPB; however, hypoxia (oxygen saturation < 90%) occurred in 11 (19.6%) patients post-CPB, which required treatment with continuous positive airway pressure. Fifteen (26.8%) patients had hypotension secondary to capnothorax, which was treated with transfusion and vasopressors. Aortic cross-clamp time was 43.6 ± 11.2 minutes, and CPB time was 106.7 ± 12.4 minutes. The median intensive care unit stay was 21 hours and postoperative hospital stay was 4 to 7 days. CONCLUSIONS The key issue for anesthetic management of robot-assisted totally endoscopic ASD repair is maintaining stable hemodynamics and oxygenation, especially during one-lung ventilation and capnothorax.
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Affiliation(s)
- Gang Wang
- Department of Cardiovascular Surgery and PLA Institute of Cardiac Surgery, General Hospital of PLA, Beijing 100853, China.
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Vernick WJ, Woo JY. Anesthetic considerations during minimally invasive mitral valve surgery. Semin Cardiothorac Vasc Anesth 2012; 16:11-24. [PMID: 22361820 DOI: 10.1177/1089253211434591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in instruments and visualization tools as well as circulatory systems for cardiopulmonary bypass during the late 1990s have stimulated widespread adoption of minimally invasive mitral valve surgery (MIMVS). Today, MIMVS is the standard approach for many surgeons and institutions. There are multiple benefits of MIMVS. Patient satisfaction and improved cosmesis are important. Additionally, studies have consistently shown faster recovery times and less associated pain with MIMVS. Statistically significant improvement in bleeding, transfusion, incidence of atrial fibrillation, and time to resumption of normal activities with MIMVS has also been shown when comparing MIMVS with conventional mitral surgery. Most important, these benefits have been achieved without sacrificing perioperative safety or durability of surgical repair. Although a steep learning curve still exists given the high level of case complexity, continued development fueled by increasing patient demand may allow for even further expansion in the use of minimal invasive techniques.
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Affiliation(s)
- William J Vernick
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Folliguet TA, Dibie A, Philippe F, Larrazet F, Slama MS, Laborde F. Robotic coronary artery bypass grafting. J Robot Surg 2010; 4:241-6. [PMID: 27627952 DOI: 10.1007/s11701-010-0219-6] [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: 08/13/2009] [Accepted: 09/25/2010] [Indexed: 11/29/2022]
Abstract
Robotically assisted surgery enables coronary surgery to be performed totally or partially endoscopically. Using the Da Vinci robotic technology allows minimally invasive treatments. We report on our experience with coronary artery surgery in our department: patients requiring single or double vessel surgical revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. From April 2004 to May 2008, 55 consecutive patients were enrolled in the study, and were operated on by a single surgical team. Operative outcomes included operative time, estimated blood loss, transfusions, ventilation time, intensive care unit (ICU) and hospital length of stay. Average operative time was 270 ± 101 min with an estimated blood loss of 509 ± 328 ml, a postoperative ventilation time of 6 ± 12 h, ICU stay of 52 ± 23 h, and a hospital stay of 7 ± 3 days. Nine patients (16%) were converted to open techniques, and transfusion was required in four patients (7%). Follow-up was complete for all patients up to 1 year. There was one hospital death (1.7%) and two deaths at follow-up. Coronary anastomosis was controlled in 48 patients by either angiogram or computed tomography scan, revealing occlusion or anastomotic stenoses (>50%) in six patients. Overall permeability was 92%. Major adverse events occurred in 12 patients (21%). One-year survival was 96%. Our initial experience with robotically assisted coronary surgery is promising: it avoids sternotomy and with a methodical approach we were able to implement the procedure safely and effectively in our practice, combining minimal mortality with excellent survival.
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Affiliation(s)
- Thierry A Folliguet
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
| | - Alain Dibie
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - François Philippe
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Fabrice Larrazet
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Michel S Slama
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - François Laborde
- Department of Cardio-vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
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Folliguet TA, Dibie A, Philippe F, Larrazet F, Slama MS, Laborde F. Robotically-assisted coronary artery bypass grafting. Cardiol Res Pract 2010; 2010:175450. [PMID: 20339505 PMCID: PMC2842890 DOI: 10.4061/2010/175450] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/18/2009] [Accepted: 02/02/2010] [Indexed: 11/20/2022] Open
Abstract
Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery.
Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart.
Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 ± 104 minutes and for MIDCAB was 220 ± 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.
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Affiliation(s)
- Thierry A Folliguet
- Department of Cardio-Vascular Surgery, L'Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
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Anesthetic considerations for a steroid-dependent high-risk patient undergoing minimally invasive cardiac surgery. Can J Anaesth 2008; 55:53-5. [PMID: 18166750 DOI: 10.1007/bf03017599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Park YS, Lee YK, Baek SH, Jeong SM, Hwang JH. Unexpected cardiac tamponade during robot-assisted permanent pacemaker insertion -A case report-. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.4.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Young-soo Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seung Hye Baek
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung-moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jai Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Goel S, Bainbridge D. Anaesthetic management for the patient of large ostium secundum and severe mitral regurgitation with addison’s disease undergoing minimally invasive cardiac surgery. Can J Anaesth 2007. [DOI: 10.1007/bf03019947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Choi YS, Kwak YL, Jeon DH, Hong YW, Park HK. Anesthesia for Robotic Repair of the Atrial Septal Defect - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.3.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Jeon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Woo Hong
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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