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Hwang B, Ren J, Wang K, Williams ML, Yan TD. Systematic review and meta-analysis of two decades of reported outcomes for robotic coronary artery bypass grafting. Ann Cardiothorac Surg 2024; 13:311-325. [PMID: 39157187 PMCID: PMC11327407 DOI: 10.21037/acs-2023-rcabg-0191] [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: 11/20/2023] [Accepted: 04/23/2024] [Indexed: 08/20/2024]
Abstract
Background Despite the well-documented safety and feasibility of robotic coronary artery bypass grafting (CABG), widespread adoption of this approach remains limited by its steep learning curve, high procedural costs and paucity of data on longer-term efficacy. This current meta-analysis aims to provide a systematic overview of the outcomes of robot-assisted CABG, with a focus on long term graft patency and freedom from major adverse cardiac and cerebrovascular events (MACCE). Methods A systematic literature search of three electronic databases was conducted for studies reporting outcomes of robotic-assisted CABG, and were grouped based on whether patients underwent robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB), totally endoscopic coronary artery bypass (TECAB) or were mixed. Perioperative and mid-to-long term results from included studies were pooled using meta-analysis of proportion or means in a random effects model. Results In the quantitative analysis, thirty-nine eligible studies included 6,152 patients who underwent RA-MIDCAB, 1,729 patients who underwent TECAB and 21,642 patients who underwent either form of robot-assisted CABG. A high level of heterogeneity was observed amongst baseline characteristics. Perioperative mortality and complication rates were low. Conversion rate to full sternotomy overall was less than 3.2% [95% confidence interval (CI): 2.1-5.2%, I2=39%]. At a mean follow-up duration of 5.2 years, overall graft patency was 96% for both RA-MIDCAB and TECAB, and freedom from major adverse cardiac events (MACE) or MACCE was 83.2% (95% CI: 72.0-90.4%; I2=90%) for RA-MIDCAB and 91.6% (95% CI: 86.6-94.9%; I2=76%) for TECAB. Conclusions Robot-assisted CABG is observed to have acceptable perioperative and mid-to-long term outcomes with promising overall graft patency.
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Affiliation(s)
- Bridget Hwang
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Justin Ren
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Katherine Wang
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael L. Williams
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Tristan D. Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Kremer R, Aboud W, Haberfeld O, Armali M, Barak M. Differential lung ventilation for increased oxygenation during one lung ventilation for video assisted lung surgery. J Cardiothorac Surg 2019; 14:89. [PMID: 31060627 PMCID: PMC6503433 DOI: 10.1186/s13019-019-0910-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One lung ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection. PATIENTS AND METHOD This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV + CPAP and OLV + DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage. RESULTS Oxygenation during OLV+ CPAP was significantly lower that OLV + DLV (p = 0.018). There were insignificant alterations of pH, PCO2 and HCO3 during the different ventilating modes. The surgeons' assessments of interference in the field exposure between OLV + CPAP or OLV + DLV was found to be insignificant (p = 0.073). CONCLUSIONS During OLV, DLV is superior to CPAP in improving patient's oxygenation, and may be used where CPAP failed. TRIAL REGISTRATION ClinicalTrials.gov NCT03563612 . Registered 9 June 2018, retrospectively (due to clerical error).
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Affiliation(s)
- Ran Kremer
- Department of Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Wisam Aboud
- Department of Anesthesiology, the Baruch Padeh Medical Center, Poriya, Tiberius, Israel
| | - Ori Haberfeld
- Department of Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Maruan Armali
- Department of Anesthesiology, the Baruch Padeh Medical Center, Poriya, Tiberius, Israel
| | - Michal Barak
- Department of Anesthesiology, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, POB 9602, 31096, Haifa, Israel.
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Le HND, Nguyen H, Wang Z, Opfermann J, Leonard S, Krieger A, Kang JU. Demonstration of a laparoscopic structured-illumination three-dimensional imaging system for guiding reconstructive bowel anastomosis. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 29797865 PMCID: PMC5964336 DOI: 10.1117/1.jbo.23.5.056009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/30/2018] [Indexed: 05/11/2023]
Abstract
This paper reports the development and system analysis of a laparoscopic system based on structured illumination technique capable of three-dimensional (3-D) reconstruction of porcine intestine during surgical anastomosis (connection of tubular structures). A calibration target is used to validate the system performance and results show a depth of field of 20 mm with an accuracy of 0.008 mm and precision of 0.25 mm. The imaging system is used to reconstruct a quantitative 3-D depth measurement of ex vivo porcine bowel tissues to mimic an end-to-end bowel anastomosis scenario. We demonstrate that the system can detect a suture in the tissue and map homogeneous surfaces of the intestine with different tissue pigments, affirming the feasibility for depth quantization for guiding and assisting medical diagnostic decisions in anastomosis surgery.
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Affiliation(s)
- Hanh N. D. Le
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Hieu Nguyen
- Catholic University of America, Department of Mechanical Engineering, Washington, DC, United States
| | - Zhaoyang Wang
- Catholic University of America, Department of Mechanical Engineering, Washington, DC, United States
| | - Justin Opfermann
- Children’s National Health System, Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, United States
| | - Simon Leonard
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Axel Krieger
- University of Maryland, Department of Mechanical Engineering, College Park, Maryland, United States
| | - Jin U. Kang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
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Malik V, Jha AK, Kapoor PM. Anesthetic challenges in minimally invasive cardiac surgery: Are we moving in a right direction? Ann Card Anaesth 2017; 19:489-97. [PMID: 27397454 PMCID: PMC4971978 DOI: 10.4103/0971-9784.185539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Continuously growing patient's demand, technological innovation, and surgical expertise have led to the widespread popularity of minimally invasive cardiac surgery (MICS). Patient's demand is being driven by less surgical trauma, reduced scarring, lesser pain, substantially lesser duration of hospital stay, and early return to normal activity. In addition, MICS decreases the incidence of postoperative respiratory dysfunction, chronic pain, chest instability, deep sternal wound infection, bleeding, and atrial fibrillation. Widespread media coverage, competition among surgeons and hospitals, and their associated brand values have further contributed in raising awareness among patients. In this process, surgeons and anesthesiologist have moved from the comfort of traditional wide incision surgeries to more challenging and intensively skilled MICS. A wide variety of cardiac lesions, techniques, and approaches coupled with a significant learning curve have made the anesthesiologist's job a challenging one. Anesthesiologists facilitate in providing optimal surgical settings beginning with lung isolation, confirmation of diagnosis, cannula placement, and cardioplegia delivery. However, the concern remains and it mainly relates to patient safety, prolonged intraoperative duration, and reduced surgical exposure leading to suboptimal treatment. The risk of neurological complications, aortic injury, phrenic nerve palsy, and peripheral vascular thromboembolism can be reduced by proper preoperative evaluation and patient selection. Nevertheless, advancement in surgical instruments, perfusion practices, increasing use of transesophageal echocardiography, and accumulating experience of surgeons and anesthesiologist have somewhat helped in amelioration of these valid concerns. A patient-centric approach and clear communication between the surgeon, anesthesiologist, and perfusionist are vital for the success of MICS.
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Affiliation(s)
- Vishwas Malik
- Department of Cardiac Anesthesia, AIIMS, New Delhi, India
| | - Ajay Kumar Jha
- Department of Anesthesiology, AIIMS, Bhubaneswar, Odisha, India
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Minimally invasive surgical techniques in the era of hybrid coronary revascularization: additional benefits for the elderly patients? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:875-879. [PMID: 27928232 PMCID: PMC5131205 DOI: 10.11909/j.issn.1671-5411.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Canale L, Mick S, Nair R, Mihaljevic T, Bonatti J. Atrial Fibrillation After Robotic Cardiac Surgery. J Atr Fibrillation 2014; 7:1019. [PMID: 27957073 DOI: 10.4022/jafib.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/16/2014] [Accepted: 05/19/2014] [Indexed: 12/13/2022]
Abstract
Atrial fibrillation is one of the commonest complications after cardiac surgery and it is associated with considerable morbidity and increase in mortality. Recently, robotic approach to many heart operations has become feasible and reproducible. We here investigate and review the incidence of atrial fibrillation after robotic cardiac surgery. We found that its incidence is overall low and less than in conventional heart surgery.
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Affiliation(s)
| | - Stephanie Mick
- Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Ravi Nair
- Cleveland Clinic, Cleveland, Ohio, United States of America
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Canale LS, Mick S, Mihaljevic T, Nair R, Bonatti J. Robotically assisted totally endoscopic coronary artery bypass surgery. J Thorac Dis 2014; 5 Suppl 6:S641-9. [PMID: 24251021 DOI: 10.3978/j.issn.2072-1439.2013.10.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/29/2013] [Indexed: 01/06/2023]
Abstract
Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the "best of both worlds" from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations.
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