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OBJECTIVE: Robotic-assisted (RA) minimally invasive cardiac surgery was introduced back in 1990’ by Carpentier and Chitwood. Despite satisfactory clinical outcomes, the prolonged surgical time, mandatory long learning curve and increased cost limited the extension of such technology. We introduced RA cardiac surgery program in early 2000. The program, however, was abandoned due to the demanding process of staff-teaching and the increased cost of each procedure compared to the standard practice. The RA program was re-started in 2010 at our University Hospital, including different specialities (general surgery, urology, pediatric surgery, ENT). Here we report the results of our hospital based multidisciplinary RA surgery program
METHODS: Since June 2010 an Institutional RA surgical program was started at our Hospital. Different surgical specialities included in the program, shared the same surgical theatre and a dedicated, specifically trained staff. An averaged of 1.5 session/pw was scheduled for each speciality according to the potential waiting list. Overall results of such experience are revised and analysed.
RESULTS:
A total of 337 procedures have been included in the multidisciplinary RA surgical program (Fig 1 A). Robotic theatre was routinely used every day. Availability of robotic theatre each week allowed a quicker learning curve with a gradual reduction of surgical time for each speciality. Cardiothoracic surgery procedures were 68. Based on a significant improvement in terms of surgical time (Fig 1 B) such approach has nowadays become standard approach in case of ASD and has become more and more frequent in case of mitral valve surgery.
CONCLUSIONS: The potential of using robotic device routinary every week allowed for a significant extension of the robotic program within each surgical speciality followed by reduced surgical time matching, in selected procedures, those of conventional approach. In conclusion a robotic-assisted surgery program seems to be really cost-effective only if different specialities are included and a dedicated theatre and staff is allocated. The frequent application of such technology significantly reduce the learning curve allowing improved clinical benefit.