Outcomes Comparison of Robot-Assisted and Video-Assisted Thoracoscopic Cardiac Sympathetic Denervation

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Robotic Surgery

Background:

• Cardiac sympathetic denervation (CSD) is an antiadrenergic surgical procedure for managing sustained ventricular tachyarrhythmia (VT).
• Video-assisted thoracoscopic surgery (VATS) is the current standard for CSD, but robotic-assisted thoracoscopic surgery (RATS) feasibility is under investigation.

Purpose of the Study:

• To compare the short-term outcomes of RATS versus VATS for CSD.
• To evaluate the effectiveness of RATS in reducing implantable cardioverter defibrillator (ICD) shock burden in VT patients.

Main Methods:

• A retrospective study of 67 adult patients undergoing CSD between 2015 and 2021.
• Comparison of perioperative outcomes and 1-year efficacy between RATS (n=34) and VATS (n=33) groups.

Main Results:

• RATS procedures had significantly shorter durations (median 129 min) compared to VATS.
• VATS was associated with higher rates of pneumothorax and overall complications.
• Both RATS and VATS significantly reduced ICD shock burden at 1 year (median 4 to 0 shocks), with similar outcomes between groups.

Conclusions:

• RATS cardiac denervation offers comparable 1-year efficacy to VATS for reducing VT recurrence.
• RATS demonstrates superior perioperative outcomes, including reduced procedure time and complications.
• Robotic CSD presents a safe and effective therapeutic alternative for patients with malignant arrhythmias.