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Published on: May 29, 2015
Feasibility of robotic-assisted atrial septal defect repair in a 6-year-old patient
Ahmet Ümit Güllü1, Şahin Şenay1, Egemen Ersin2
1Department of Cardiovascular Surgery, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey.
Insights
Robotic repair of atrial septal defect (ASD) is feasible in pediatric patients. This minimally invasive approach offers a safe alternative for congenital heart defect repair in children.
Area of Science:
- Pediatric cardiac surgery
- Minimally invasive cardiac surgery
- Robotic-assisted surgery
Background:
- While robotic repair of atrial septal defect (ASD) is established in adults, its application in pediatric patients remains limited.
- Current robotic systems present challenges for pediatric use due to instrument size, yet suitable candidates may benefit.
Observation:
- A 6-year-old child with ASD underwent successful robotic-assisted repair using the Da-Vinci Robotic System.
- The procedure involved standard venous and arterial cannulation, with a small incision for ports, carefully placed to protect developing breast tissue.
Findings:
- The robotic-assisted ASD closure was completed successfully using a primary closure technique.
- The patient experienced an uneventful perioperative period and was discharged 5 days post-surgery.
Implications:
- This case demonstrates the successful application of robotic assistance for ASD repair in a pediatric patient.
- Advancements in robotic technology, such as thinner arms, will likely increase its use in pediatric congenital heart defect repair.
Background:
The feasibility, safety and advantages of minimally invasive or robotic repair of atrial septal defect (ASD) in adults were reported previously. However, there is limited data for the application of these systems in paediatric patients. Although current robotic systems still have large instruments for surgical repair in children, some appropriate patients may benefit from this technology.
Method:
A 6-year-old child with ASD underwent robotic assistant repair via Da-Vinci Robotic Systems. Venous cannulation was achieved by internal jugular and femoral veins (10F-14F) and arterial cannulation was performed via femoral artery under transesophageal echocardiography (TEE) guidance (10F). A 3 cm incision was made in the right fourth intercostal space, used for working and the camera port in the same time. The ports were placed considering not to damage the potential developing breast tissue. After the port implantation (8F) and cardiac arrest, the ASD repair was completed with primary closure technique.
Result:
The perioperative period was uneventful and the patient was discharged from hospital 5 days after surgery.
Conclusion:
ASD closure with robotic assistant was achieved in a large enough sized paediatric patient. With the development of thinner and shorter robotic arms, it will be possible to use robotic assistance more common during the repair of congenital heart diseases.
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