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J Thorac Cardiovasc Surg 2003;126:465-468
© 2003 The American Association for Thoracic Surgery

Evolving technology

Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation

^a Department of Thoracic, Intensive Care and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt, Germany
^b Department of Anesthesiology, Intensive Care and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt, Germany

Received for publication May 21, 2002; revisions received August 26, 2002; revisions received October 23, 2002; accepted for publication November 1, 2002.

^* Address for reprints: G. Wimmer-Greinecker, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
wimmer-greinecker{at}em.uni-frankfurt.de

OBJECTIVE: Standard surgical closure of an atrial septal defect via sternotomy is a safe and effective procedure with low morbidity and mortality. Considering that young female patients are frequently operated on for atrial septal defects, a minimally invasive procedure avoiding sternotomy is convincingly desirable and led to the approach through a right anterolateral minithoracotomy. The recent clinical introduction of robotically assisted surgery further reduced skin incisions and enabled totally endoscopic procedures through ports. This article reports on a first series of atrial septal defect closures of which the first case was operated on August 24, 1999, in a totally endoscopic closed chest technique using a computer-enhanced telemanipulation system.

METHODS: We performed totally endoscopic atrial septal repair using the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif) in 10 consecutive adult patients. Median age was 45.5 ± 10.0 years, and preoperative New York Heart Association functional class was 1.8 ± 0.1. Left ventricular ejection fraction was normal in all patients and mean pulmonary artery pressure amounted to 35 ± 7 mm Hg. Shunt volume ranged from 24% to 70%. All patients displayed a fossa ovalis type of atrial septal defect; 2 of them multiperforated.

RESULTS: Neither intraoperative nor postoperative complications occurred. Two patients had to be converted to minithoracotomy due to endoaortic balloon clamp failure. Length of operation was 262 ± 37 minutes, and cardiopulmonary bypass time was 161 ± 26 minutes. Intraoperative transesophageal echocardiography certified complete closure of the atrial septal defect in all patients. The totally endoscopic computer-enhanced technique yielded excellent cosmetic results.

CONCLUSION: Totally endoscopic atrial septal repair is a feasible and safe procedure with good clinical results and excellent cosmetic outcomes. It may be considered as perfect adjunct to interventional treatment options. Further studies with larger cohorts and randomized trials are necessary to document potential benefits. Evolution in robotic technology and refinement of procedural flow may shorten procedural time and decrease costs.

Key Words: 20 • 28