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Liu Y, Ge S, Li X, Lu C, Zhang C, Liu Z. Comparative analysis of robotically-assisted versus conventional sternotomy approach in left atrial myxoma resection: A single-center retrospective observational study. Asian J Surg 2024:S1015-9584(24)00374-9. [PMID: 38443251 DOI: 10.1016/j.asjsur.2024.02.112] [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: 09/06/2023] [Revised: 12/10/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Minimally invasive surgery has emerged as a favorable alternative to conventional surgery for various cardiac conditions. This study aimed to compare the perioperative outcomes and follow-up results of the robotic approach versus the sternotomy approach for left atrial myxoma (LAM) resection. METHOD We retrospectively analyzed the perioperative outcomes and follow-up results of 94 patients who underwent left atrial myxoma resection using either the sternotomy approach (n = 64) or the robotic approach (n = 30) at our center between January 2017 and April 2023. Multiple linear regressions were employed to examine the actual impact of the surgical approach on perioperative outcomes while controlling for potential confounding factors. RESULTS There were no in-hospital deaths or follow-up deaths in the robotic group. Univariate analyses revealed that robotic LAM resection had a longer cardiopulmonary bypass (CPB) time (99.93 ± 22.30 vs. 76.28 ± 24.92, P < 0.001), longer aortic clamping time (57.80 ± 20.27 vs. 47.89 ± 18.10, P = 0.019), reduced postoperative drainage (P < 0.001), shorter mechanical ventilation time (P = 0.005), shorter postoperative bed-stay time (P < 0.001), shorter postoperative hospitalization time (P = 0.040), and higher hospital costs (P = 0.001) compared to the sternotomy group. After adjusting for baseline characteristics in a multiple regression model, a longer CPB time (B = 28.328; CI, 18.609-38.047; P < 0.001), longer aortic clamping time (B = 11.856; CI, 4.069-19.644; P = 0.003), reduced postoperative drainage (B = -200.224; CI, -254.962- -145.486; P < 0.001), shorter mechanical ventilation time (B = -3.429; CI, -6.562- -0.295; P = 0.032), shorter postoperative bed-stay time (B = -2.230; CI, -3.267- -1.193; P < 0.001), shorter postoperative hospitalization time (B = -1.998; CI, -3.747- -0.250; P = 0.026), and higher hospital costs (B = 2096.866, P = 0.002) were found in the robotic group. Furthermore, the robotic group exhibited a faster return to exercise compared to the sternotomy group (Log-Rank χ2 = 34.527, P < 0.001). CONCLUSION Both the robotic and sternotomy approaches are viable and safe options for LAM resection. However, despite the higher costs, longer CPB time, and longer aortic clamping time associated with robotic LAM resection, this technique was correlated with reduced postoperative drainage and faster postoperative recovery compared to the sternotomy technique.
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Affiliation(s)
- Yanyi Liu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Shenglin Ge
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Xin Li
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chenghao Lu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chengxin Zhang
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Zhuang Liu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Rufa M, Nagib R, Aktuerk D, Ahad S, Ghinescu M, Franke U. A propensity matched comparison of robotic vs. traditional minimal access approach for mitral valve repair with concomitant cryoablation. J Thorac Dis 2023; 15:6459-6474. [PMID: 38249871 PMCID: PMC10797378 DOI: 10.21037/jtd-23-1306] [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: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 01/23/2024]
Abstract
Background Atrial fibrillation (AF) occurs frequently in patients with mitral valve disease. Results of cryoablation concomitant with either minimally invasive video-assisted [minimally invasive mitral valve surgery (MIMVS)] or with robotic-assisted (RMV) mitral valve surgery have previously been separately reported. However, there are up-to-date no studies comparing the two procedures in terms of safety, efficacy, and mid-term follow-up. Methods Between January 2017 and March 2022, 294 patients underwent MIMVS, and 187 patients underwent RMV at our institution. After 1:1 propensity score matching using 22 preoperative variables, the study included 104 patients. Group 1 (MIMVS) included 52 patients operated on between 2017-2022 using a minimally invasive video-assisted right-sided mini-thoracotomy. Group 2 (RMV) included 52 patients operated on between 2019-2021 using a robotic-assisted approach. Early and mid-term outcomes were assessed, including maintenance of sinus rhythm. Follow-up was 100% complete at a median follow-up of 2 years. Results For the entire propensity matched cohort, the median EuroSCORE II was 3.14 [interquartile range (IQR), 1.93-4.99], the median age was 68 (IQR, 61-74) years, and two thirds of the patients were male. Most (72.1%) underwent mitral valve surgery, and 26.9% had an additional tricuspid procedure. Only four patients underwent mitral valve replacement (3.8%). The majority (87.5%) received a left-sided atrial Maze and 12.5% a bi-atrial Maze. The left atrial appendage was occluded in 72.1% cases. Overall, there were no significant differences between the two propensity matched groups in baseline demographics or intra-operative characteristics. Similarly, there were no significant differences in the post-operative short and mid-term outcomes between the two groups. There were no in-hospital or 30-day deaths. At the mid-term survival was similar between groups, log-rank test P=0.056. Maintenance of sinus rhythm at follow-up was 76%. Conclusions Mitral or double valve repair with concomitant cryoablation can be safely performed with either a MIMVS or RMV approach. Both methods demonstrated outstanding early and mid-term outcomes.
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Affiliation(s)
- Magdalena Rufa
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ragi Nagib
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Samir Ahad
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Mihnea Ghinescu
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ulrich Franke
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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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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4
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Liu Y, Liu Z, Li X, Jiang Y, Lu C, Zhang C, Ge S. A comparison of total thoracoscopic versus robotic approach for cardiac myxoma resection: a single-center retrospective study. J Robot Surg 2023:10.1007/s11701-023-01531-z. [PMID: 36648634 PMCID: PMC10374789 DOI: 10.1007/s11701-023-01531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
Advances in instrumentation and technique have facilitated minimally invasive surgeries for cardiac myxoma treatment. This study aims to compare the clinical outcomes between the thoracoscopic and robotic approaches for myxoma resection. Intraoperative data and postoperative data of 46 patients who underwent either thoracoscopic (n = 15) or robotic (n = 31) cardiac myxoma resection in our center between July 2013 and September 2022 were retrospectively compared. There was no in-hospital death in either group. Meanwhile, the operative time and cardiopulmonary bypass time were significantly shorter in the robotic group than in thoracoscopic group (P = 0.015 and P = 0.035, respectively). Furthermore, shorter ICU stays (P = 0.006), shorter postoperative mechanical ventilation time (P = 0.035) and less thoracic drainage (P = 0.040) were observed in the robotic group. However, the operating room costs and total hospital costs were both significantly lower in thoracoscopic group (P = 0.004 and P = 0.007, respectively). There was no significant difference between two groups regarding the incidence of postoperative complications (P > 0.05). Lastly, a faster return to exercise was noted in robotic group than in thoracoscopic group (Log-Rank χ2 = 4.094, P = 0.043). Both approaches can be safe and feasible for myxoma resection. However, regardless of higher expenses, the robotic myxoma resection approach provides shorter operation time, less postoperative thoracic drainage, and faster recovery than total thoracoscopic technique.
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Affiliation(s)
- Yanyi Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Zhuang Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Xin Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Yiyao Jiang
- Department of Cardiac Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Chenghao Lu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Chengxin Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
| | - Shenglin Ge
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
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Husen TF, Kohar K, Angelica R, Saputro BIL. Robotic vs other surgery techniques for mitral valve repair and/or replacement: A systematic review and meta-analysis. Hellenic J Cardiol 2023; 71:16-25. [PMID: 36639122 DOI: 10.1016/j.hjc.2022.12.011] [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: 09/21/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Mitral valve repair or replacement (MVr/R) are procedures that aim to correct mitral regurgitation. The three techniques, namely conventional, minimally invasive, and robotic each present their advantages and setbacks. Previous studies had compared each technique with the other but mostly focused on two techniques. In this systematic review and meta-analysis, we attempt to compare all three techniques, to provide a reference for the clinical selection of the best surgical scheme. METHODS The literature search was performed in databases including PubMed, Scopus, Google Scholar, EBSCOHost, Wiley, ProQuest, and Embase, up to June 1st, 2022. Critical appraisal of studies was performed using Newcastle Ottawa Scale converted by Agency for Healthcare Research and Quality (AHRQ). We used bayesian network meta-analysis and conventional meta-analysis (random effects model) to rank and analyze pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Forest plots of pooled effect estimates comparing each treatment and ranking panel using Surface Under the Cumulative Ranking (SUCRA) were used for the intervention measures. RESULTS A total of 18 studies with 60,331 patients were included in this systematic review and meta-analysis. Hospital stay was significantly lower in the group with robotic procedure compared to the conventional interventions in terms of ICU stay and overall length of stay. The mean difference of length of hospital stay days of the conventional group was 2.27 (1.31-3.30) days and of the minimally invasive -0.364 (-2.31-1.53) days compared to the robotic group. The robotic procedure was associated with longer cross-clamp and cardiopulmonary bypass (CPB) times. Nevertheless, the robotic procedure was associated with lower infection (OR = 0.60 [95% CI 0.50-0.73)] rates and in-hospital mortality compared to conventional techniques (OR=0.53 [95% CI 0.40-0.70)] but not the minimally invasive techniques (OR = 1.74 [95% CI 0.48-6.31]). CONCLUSION Robotic surgery showed more favorable surgical outcomes, including hospital stay, post-operational complications and in-hospital mortality, although it was associated with longer cross-clamp time and CPB time compared to other interventions. However, its high cost is a difficult consideration for its widespread clinical implementation.
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Affiliation(s)
- Theresia Feline Husen
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia.
| | - Kelvin Kohar
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia
| | - Ruth Angelica
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia
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Fatehi Hassanabad A, Nagase FNI, Basha AM, Hammal F, Menon D, Kent WDT, Ali IS, Nagendran J, Stafinski T. A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:471-481. [PMID: 36529985 PMCID: PMC9846568 DOI: 10.1177/15569845221141488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. METHODS A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. RESULTS The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. CONCLUSIONS Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada,Ali Fatehi Hassanabad, MD, MSc, Section of
Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute,
Foothills Medical Center, 1403, 29th Street NW, Calgary, Alberta, T2N2T9,
Canada.
| | - Fernanda N. I. Nagase
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ameen M. Basha
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Fadi Hammal
- School of Public Health, University of
Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Imtiaz S. Ali
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department
of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton,
AB, Canada
| | - Tania Stafinski
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
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Zheng CR, Mazur P, Arghami A, Jahanian S, Viehman JK, King KS, Dearani JA, Daly RC, Rowse PG, Bagameri G, Crestanello JA. Robotic vs. minimally invasive mitral valve repair: A 5-year comparison of surgical outcomes. J Card Surg 2022; 37:3267-3275. [PMID: 35989503 DOI: 10.1111/jocs.16849] [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: 04/18/2022] [Revised: 06/15/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr. METHODS We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores. RESULTS Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p < .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively). CONCLUSIONS Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.
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Affiliation(s)
- Clark R Zheng
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sepideh Jahanian
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason K Viehman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis. Emerg Med Int 2022; 2022:5371493. [PMID: 36193543 PMCID: PMC9525788 DOI: 10.1155/2022/5371493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 12/07/2022] Open
Abstract
Robotic surgery can provide less surgical trauma than conventional surgery, but differences between robotic and thoracoscopic surgery for atrial septal defect (ASD) repair are not well documented. To explore whether ASD can be repaired by thoracoscopic surgery or robotic surgery, which procedure is less invasive, and the difference in outcomes between these two procedures, this article studies 160 patients undergoing ASD repair at our institution. Sixty-five patients underwent total thoracoscopic surgery and 95 patients underwent total endoscopic robotic surgery. Propensity score matching yielded 64 well-matched patient pairs. Surgical data and early postoperative outcomes between the two matched groups were analyzed and compared. The results show that thoracoscopic and robotic surgery to repair ASD are both safe and reliable, and the early curative effect is good. However, regardless of similar complication rates, robotic surgery has a shorter time, less postoperative drainage, and faster recovery than thoracoscopic surgery.
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Song C, Wei S, Fan Y, Jiang S. Comparison of clinical outcomes for total robotic versus total thoracoscopic mitral repair. J Card Surg 2022; 37:1129. [PMID: 35060191 DOI: 10.1111/jocs.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chao Song
- Medical School of Chinese PLA Beijing China
- Department of Cardiovascular Surgery The First Medical Centre of Chinese PLA General Hospital Beijing China
| | - Shixiong Wei
- Medical School of Chinese PLA Beijing China
- Department of Cardiovascular Surgery The First Medical Centre of Chinese PLA General Hospital Beijing China
| | - Yunlong Fan
- Medical School of Chinese PLA Beijing China
- Department of Cardiovascular Surgery The First Medical Centre of Chinese PLA General Hospital Beijing China
| | - Shengli Jiang
- Department of Cardiovascular Surgery The First Medical Centre of Chinese PLA General Hospital Beijing China
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Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, Komlo C, Guy TS. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Rev Med Devices 2021; 18:955-970. [PMID: 34325594 DOI: 10.1080/17434440.2021.1960506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery has developed for more than 20 years. The main purpose of robotic assistance is to use multiwristed instruments for surgical endothoracic maneuvers on the mitral valve without opening the chest. The surgeon controls the instruments remotely from a console but is virtually immersed into the operative field. AREAS COVERED This review outlines indications and contraindication for the procedure. Intra- and postoperative results as available in the literature are reported. Further areas focus on the technological development, advances in surgical techniques, training methods, and learning curves. Finally we give an outlook on the potential future of this operation. EXPERT OPINION Robotic assistance allows for the surgically least invasive form of mitral valve operations. All variations of robotic mitral valve repair and replacement are feasible and indications have recently been broadened. Improved dexterity of instrumentation, 3D and HD vision, introduction of a robotic left atrial retractor, and adjunct technology enable most complex forms of minimally invasive mitral valve interventions through ports on the patient's right chest wall. Application of robotics results in significantly reduced surgical trauma while maintaining safety and outcome standards in mitral valve surgery.
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Affiliation(s)
- Johannes Bonatti
- UPMC Heart and Vascular Institute and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Caroline Komlo
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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