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Updated: Aug 6, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Concomitant intra-atrial excision of the left atrial appendage during robotic-assisted minimally invasive cardiac
Mihnea Ghinescu1, Ulrich F W Franke1, Melisa Ortega1
1Department of Cardiovascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
Insights
A new intra-atrial technique for excising the left atrial appendage (LAA) offers a safe and effective method for reducing stroke risk in cardiac surgery patients. This approach is suitable for minimally invasive procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Surgical closure of the left atrial appendage (LAA) reduces stroke risk in atrial fibrillation patients.
- Minimally invasive cardiac surgery presents challenges for external LAA closure techniques.
- Existing internal closure methods risk LAA reperfusion.
Purpose of the Study:
- To present a novel technique for intra-atrial LAA excision and defect closure.
- To address limitations of external LAA closure in minimally invasive cardiac surgery.
- To offer a safe and effective alternative for LAA management.
Main Methods:
- The technique involves invaginating the LAA into the left atrium and excising it at the base.
- Closure is achieved internally using a two-layer looped PTFE suture.
- Detailed step-by-step description provided for robotic-assisted cardiac surgery.
Main Results:
- Complete LAA resection without residual stump or bleeding was achieved in all 20 patients.
- No procedure-related complications were observed.
- The technique demonstrated efficacy and safety in preliminary cases.
Conclusions:
- Intra-atrial LAA excision is a promising technique for robotic-assisted cardiac operations.
- The method is safe, effective, and reproducible.
- Recommended for right-sided minimally invasive cardiac surgical procedures.
Objective:
Surgical closure of the left atrial appendage (LAA) in patients with atrial fibrillation undergoing cardiac surgery can decrease the risk of stroke and thromboembolism and should therefore be considered. In minimally invasive, thoracoscopic, or robotic-assisted mitral valve surgery, however, external procedures such as clip application or epicardial resection are not feasible due to anatomic limitations and the reduced size of the access port. Internal suture closing techniques bear the risk of recurrent LAA reperfusion, so far. We present a novel surgical technique of LAA excision and subsequent defect closure from the interior aspect of the atrium.
Methods:
We developed this novel technique during robotic-assisted cardiac surgeries. In short, the LAA is invaginated into the left atrium, excised completely at the base using scissors and the stump is then closed from the inside with a two-layer looped PTFE suture. We give a detailed step-by-step description of the technique.
Results:
A total of 20 patients received intra-atrial LAA excision so far. Complete resection of the LAA without any residual stump or bleeding was achieved in all cases. There were no procedure-related complications.
Conclusion:
The intra-atrial LAA excision technique shows promising preliminary results regarding efficacy, safety, and reproducibility during robotic-assisted cardiac operations and could be recommended for all right-sided minimally invasive cardiac surgical procedures.
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