[Our Experience and Technical Improvement in Robot-assisted Cardiac Surgery]

Area of Science:

• Cardiac Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• The da Vinci surgical system has been utilized for internal thoracic artery harvest in minimally invasive direct coronary artery bypass (MIDCAB) since 2014.
• Robot-assisted cardiac surgery (RACS) has been applied to mitral and tricuspid valve surgery, left atrial thrombosis, and myxoma since 2016, previously performed as minimally invasive cardiac surgery (MICS).

Purpose of the Study:

• To evaluate the integration and development of RACS in various cardiac procedures.
• To assess the impact of a learning curve on surgical stability and outcomes.
• To emphasize the importance of careful RACS indication and potential conversion to thoracotomy.

Main Methods:

• Implementation of the da Vinci surgical system for specific cardiac procedures.
• Development of innovative techniques and devices (e.g., Chordalizer, COR-KNOT) to optimize RACS.
• Systematic review of surgical outcomes and challenges encountered during the learning curve.

Main Results:

• A learning curve was observed, leading to more stable RACS procedures over time.
• Various advancements and techniques were developed to improve RACS efficacy.
• The study highlights the need for careful patient selection and consideration of conversion to thoracotomy in complex cases.

Conclusions:

• RACS is a valuable tool for MICS, but its indication must be carefully considered.
• Adaptability and prompt decision-making, including conversion to thoracotomy when necessary, are crucial for patient safety.
• Further enhancements in technology and technique are expected to expand RACS indications and improve outcomes.