Totally robotic technique in multivessel coronary disease--is it possible?

Recent advances in minimal-access cardiac surgery using robotic-enhanced surgical systems

Recent advances in interventional cardiology and cardiac surgery have changed traditional therapeutic algorithms by altering indications, timing and patterns of referral for subsequent surgical treatment. Developments in coronary revascularization have focused on reducing both surgical invasiveness and trauma. Patients with significant comorbid pathologies, those undergoing reinterventions and especially the elderly may benefit from such hybrid procedures by avoiding cardiopulmonary bypass and a midline sternotomy. Minimally invasive techniques have revolutionized cardiothoracic surgery by increasing patient satisfaction and by reducing surgical trauma, hospital stay, and consequently overall costs. There are, however, limitations, but robot-assisted surgery endeavors to minimize these technical hindrances and thus allow better and more accurate surgical practice whilst minimizing surgical trauma.

Robotic ocular surgery

BACKGROUND

Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures.

AIMS

To examine the use of a commercially available surgical robot for ocular microsurgery.

METHODS

Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360 degrees -rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography.

RESULTS

Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level.

CONCLUSIONS

Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state-of-the-art surgical skill and technology.

Minimal access coronary revascularisation without cardiopulmonary bypass—the impact of robotic technology in the current clinical practice

Recent advances in interventional cardiology and cardiac surgery have changed the traditional therapeutic algorithms by altering indications, timing and patterns of referral for subsequent surgical treatment. The traditional longitudinal sternomy incision has been the surgical approach of choice for multi-vessel coronary revascularisation. Drawbacks of this incision include potential postoperative morbidity, which translates to a prolonged postoperative length of stay. The combination of minimally invasive direct coronary artery bypass (MIDCAB) with percutaneous transluminal coronary angioplasty (PTCA) or stenting (a hybrid approach) is an alternative therapeutic method for patients with multivessel coronary artery disease. Recent advances in percutaneous interventions have attempted to address the problem of re-stenosis, initially through the deployment of bare metal intra-coronary stents and, more recently, with drug-eluting stents. Developments in coronary revascularisation have focused on reducing both surgical invasiveness and trauma. Patients with significant co-morbid pathologies, the ones undergoing re-interventions, and especially the elderly may benefit from such hybrid procedures by avoiding cardiopulmonary bypass and midline sternotomy. Minimally invasive techniques have revolutionized cardiothoracic surgery by increasing patient satisfaction and by reducing surgical trauma, hospital stay and consequently overall costs. There are however limitations. Robot assisted surgery endeavours to minimise these technical hindrances and so allow better and more accurate surgical practice whilst minimising surgical trauma.