Computer-enhanced "robotic" cardiac surgery: experience in 148 patients

Area of Science:

• Minimally invasive cardiac surgery
• Robotic-assisted surgery
• Cardiovascular procedures

Background:

• Minimizing surgical access in cardiac procedures is a key goal.
• Advanced instrumentation systems offer potential for improved dexterity and precision.

Purpose of the Study:

• To evaluate the safety and efficacy of a computer-enhanced instrumentation system in cardiac surgery.
• To assess the application of the da Vinci telemanipulation system in coronary artery bypass grafting and mitral valve repair.

Main Methods:

• The da Vinci telemanipulation system was used in 148 patients.
• Procedures included minimally invasive direct coronary bypass, standard-sternotomy coronary bypass with robotic assistance, total endoscopic coronary artery bypass grafting (arrested and beating heart), and mitral valve repair.
• Closed-chest cardiopulmonary bypass was utilized for arrested-heart procedures.

Main Results:

• The system enabled precise tissue handling for complex tasks like coronary anastomosis and mitral valve repair.
• Internal thoracic artery takedown was successful in 79/81 patients, with a learning curve of under 40 minutes.
• Postoperative patency rates were 96.3% for minimally invasive bypass and 95.4% for total endoscopic bypass at 3 months.
• Successful closed-chest beating-heart bypass grafting was achieved in 2/8 patients.
• Endoscopic mitral valve repair was successful in 14/17 patients.
• Overall mortality was 2.0% and not related to the system.

Conclusions:

• Computer-enhanced endoscopic cardiac surgery is safe and effective in selected patients.
• Internal thoracic artery takedown is a routine procedure with good outcomes.
• Total endoscopic coronary bypass on the arrested heart is feasible but offers no significant advantage over minimally invasive approaches.
• Closed-chest beating-heart bypass grafting shows limitations but has procedural successes.