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Comparison of endoscopic robotic versus sternotomy approach for the resection of left atrial tumors
Emmanuel Moss1, Michael E. Halkos1, Jeffrey S. Miller1, Patrick Kilgo2, Douglas A. Murphy1.
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA, 2Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
OBJECTIVE: Primary cardiac tumors most commonly occur in the left atrium. The aim of this study was to compare outcomes among patients undergoing isolated left atrial tumor resection via a transsternal or robotic approach.
METHODS: From 2003 to 2013, 69 patients underwent isolated left atrial tumor resection at three affiliated hospitals with either a transsternal(n=39) or robotic approach (n=30). A retrospective review of prospectively collected data was performed and outcomes were compared between the sternotomy and robotic-assisted groups. Univariate and multivariate analyses controlling for pertinent preoperative characteristics were performed.
RESULTS: Patients characteristics in the 2 groups were similar with the exception of a history of chronic obstructive pulmonary disease (sternotomy = 12.8% vs robotic = 0%, p <0.04) and elective surgical status (sternotomy = 64.1% vs robotic = 93.3%, p<0.02). On univariate analysis, robotic assisted surgery was associated with significantly shorter postoperative mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and a lower rate of perioperative blood transfusion (See Table). After controlling for patient comorbidity in a multiple logistic regression model, there remained a trend toward decreased blood transfusions (AOR 0.33, CI 0.09-1.20, p = 0.09),shorter ICU (16.3 fewer hours, p=0.11), and hospital LOS (1.1 fewer days, p=0.17) in the robotic group. There were two postoperative strokes in the sternotomy group and none in the robotic group (p=0.21).
CONCLUSIONS: Robotic assisted left atrial tumor resection is safe and may be associated with a lower incidence of perioperative blood transfusion as well as shorter mechanical ventilation time, and shorter ICU and hospital length of stay.
| Variable | Robotic (n=30) | Sternotomy (n= 39) | p-value |
| Mechanical ventilation (hours) | 4.3 ± 5.2 | 13.8 ± 34.8 | 0.012 |
| ICU LOS | 26.1 ± 17.7 | 45.5 ± 47.7 | 0.002 |
| Hospital LOS | 4.3 ± 1.8 | 5.8 ± 3.3 | 0.005 |
| Peri-operative transfusions (n,%) | 6 (20.0) | 22 (56.2) | 0.004 |
| Stroke (n,%) | 0 (0.0) | 2 (5.1) | 0.21 |
| Death (n,%) | 0 (0.0) | 1 (2.6) | 0.38 |
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