Pericardial patch closure of an atrial septal defect using endoscopic robotic technology

Significant progress has been made over the last several years in the area of minimally invasive cardiac surgery with beneficial clinical results and increased patient satisfaction. With the addition of robotic technology to the cardiac operating room come improvements in technical manual dexterity and decreased surgical trauma. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect (ASD) using a combination of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) and the PORT ACCESS System (CardioVations, Sommerville, NJ, USA) for full cardiopulmonary bypass (CPB). CPB, aortic occlusion, and cardioplegia delivery were accomplished via peripheral cannulation with the PORT ACCESS System. Two robotic arms, one endoscopic camera, and one working incision were placed through ports in the thorax. The ASD was closed with a gluteraldehyde fixed pericardial patch using both running and interrupted suture. CPB and aortic occlusion times were 160 and 93 min, respectively. The patient was discharged on the second postoperative day and returned to normal lifestyle shortly thereafter. The benefits of peripheral access CPB and robotic technology to patients who do not want a median sternotomy provide an alternative method to traditional surgical intervention.