Robotically-assisted, totally endoscopic myocardial bridge unroofing: surgical technique.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Robotic Surgery

Background:

• Myocardial bridging (MB) is a congenital coronary anomaly where an artery segment runs within the heart muscle.
• Symptomatic MB can lead to ischemia, arrhythmias, and sudden cardiac death.
• Surgical unroofing is the gold standard for refractory cases, with robotic approaches emerging.

Purpose of the Study:

• To detail the technique for robotic myocardial bridge unroofing.
• To highlight the advantages of a totally endoscopic approach.
• To present robotic unroofing as an evolution in surgical management.

Main Methods:

• Preoperative assessment including CT angiography and physiological testing.
• Utilizing the da Vinci Xi robotic system with four 8-mm ports.
• Employing femoral cannulation and endoaortic balloon occlusion for cardioplegia.

Main Results:

• Robotic unroofing allows precise LAD unroofing with preserved vessel integrity.
• Minimizes surgical trauma, enhances visualization, dexterity, and precision.
• Facilitates faster recovery and superior cosmetic results compared to sternotomy.

Conclusions:

• Robotic myocardial bridge unroofing is a safe and effective minimally invasive procedure.
• It represents a significant advancement over traditional open-heart surgery.
• Specialized training is essential for successful implementation.