Robotic technology is the most advanced development of minimally invasive surgery that holds significant promise, but there are still some unresolved issues concerning its use in a clinical setting. Robotic surgical systems allow the surgeon to perform more complex maneuvers with increased precision and accuracy. These systems are also costly to purchase and maintain and they provide the surgeon with essentially no tactile feedback. The purpose of this study was to demonstrate the efficacy and safety of using the da Vinci Robotic Surgical System to perform minimally invasive cardiothoracic procedures.
Between October 2002 and May 2005, prospective data were maintained on 71 Robotic-assisted surgical procedures. Of the 71 procedures, 30 cardiothoracic minimally invasive robotic procedures were performed (18 men and 12 women). The average age was 64.5 years (range, 22-86 years). The cardiothoracic robotic surgical operations included Robotic-assisted minimal invasive direct coronary artery bypass (MIDCAB, n=12), epicardial lead placement (n=5), nissen fundoplication (n=5), esophagectomy (n=4), heller myotomy (n=1), thymectomy (n=1), posterior mediastinal/paravertebral mass resection (n=1) and pericardial window (n=1).
All procedures were completed successfully without conversion to open surgery. All Robotic-assisted MIDCAB patients had post-operative coronary angiogram and/or Computed Tomography angiogram to confirm LIMA-LAD patency. The postoperative mortality rate was zero. The morbidity rate was 13%. Complications included pulmonary embolus (n=1), pneumonia (n=1) and gastrostomy leak (n=1)which required a re-operation. The length of hospital stay ranged from 1 day to 29 days. 21 patients were discharged home within 36 hours.
Our preliminary experience suggests that Robotic-assisted cardiothoracic Surgery, although still in its infancy, is safe and feasible. However, the best indications still have to be defined. The cost-benefit ratio is being evaluated at our institution.
The da Vinci Robotic Surgical System is an important tool in the surgical armamentarium. It expands the application of minimally invasive cardiothoracic surgery by providing the tools necessary to perform delicate complex maneuvers through port incisions.
Ramzi Deeik, None.