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OBJECTIVE: We have previously reported totally endoscopic ventricular septal defect (VSD) repair in the adult using da Vinci S Surgical System. The optimal results encouraged us to extend the use of this technology for more complicated cases with VSD.
METHODS: From January 2009 to July 2010, twenty patients underwent totally endoscopic robotic VSD repair. The average age was 29.0±9.5 (range 16 to 45) years old. Nine patients were female and 11, male. The echocardiography demonstrated that the average diameter of VSD was 6.1±2.8 (range 2 to 15) mm, and 4 patients had concomitant patent foramen ovale. The VSD closure was directly secured with interrupted mattress sutures in 14 patients, and patched in 6 patients. All the procedures were completed using da Vinci robot via 3 port incisions and 2.0 to 2.5 cm working port in the right chest.
RESULTS: All patients were operated on successfully. The mean CPB and mean cross-clamp times were 94.3±26.3 (range 70 to 140) minutes and 39.1±12.9 (range 22 to 75) minutes, respectively. The mean operation time was 225.0±34.8 (range 180 to 300) minutes. The postoperative transesophageal echocardiography demonstrated intact ventricular septum. There were no residual left-to-right shunting and no permanently complete AV dissociation after operation. The mean hospital stay was 5 days. No residual shunt was found in the follow-up of mean 7 (range 1 to 22) months. The patients returned to normal function in one week without any complications.
CONCLUSIONS:
The totally endoscopic robotic VSD repair in adult patients is feasible, safe and efficacious.