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Experience of 600 cases of Robotic Cardiac Surgery
Changqing Gao, Ming Yang, Gang Wang, Jiali Wang.
PLA General Hospital, Beijing, China.

OBJECTIVE: The present study is to summarize the experience of 600 cases of various kind of robotic heart surgery performed at a single heart center.
METHODS: Six hundred patients underwent robotic cardiac surgery from January 2007 to December 2012. Of the 600 patients, 322 were male and 288 were female with a median age of 49 years old (11 to79 yr). Left port approaches were used in totally endoscopic coronary bypass graft on beating heart (n=90) and direct coronary bypass grafting with minithorocotomy on beating heart (n=140). Right port approaches were used in mitral valve repair (n=86), mitral valve replacement (n=40), atrial myxoma resection (n=45), atrial septal defect repair on arrest (n=54) or beating (n=90) heart, ventricular septal defect repair (n=20), and other robotic cardiac surgery (n=35). With left port approaches, patients were operated on via 3 port incisions in the left chest and 1 port in the left subcostal area of xiphoid process for endostabilizer on beating heart with da Vinci Si robot, and the others were completed via left minithoracotomy after IMA was taken down robotically. With right port approaches, patients were operated on via 3 ports in the right chest and a 1.5-2.0 cm working port, all the procedures were completed with the da Vinci Si robot on pump established through cannulation of femoral arteries.
RESULTS: All procedures were accomplished by the same console surgeon. Operating time was shortened significantly for all procedures with considerable learning curve. For example, for TECAB procedure, the mean time of harvesting single ITA harvesting was 35.8±10.7 minutes (18 to 70 min). Harvesting time was decreased from 41 minutes in the first 30 cases to 29 minutes in the last 30 cases (Fig). All patients underwent coronary angiography or CTA scan before discharge. One patient was converted to median sternotomy due to aortic valve perforation, and one case had hemolyses after mitral valve repair. No patient died. Our leaning curve is showed graphically in Figure. There were no device-related and pro-related complications.
CONCLUSIONS: Our study shows that robotic cardiac surgery is safe procedure, and the surgical results are excellent for selected patients.


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