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OBJECTIVE: Cardiac myxoma is the most common benign neoplasm in the heart, which shows good long-term result after surgical excision. Usually we use median sternotomy to excise all the tissues including the myxoma itself and adjacent endocardium and myocardium. Approach routes are various, such as bi-atrial, trans-septal, and left atrial, etc. Recently, Da Vinci robot is added to our surgical armamentarium. We analyzed our result of robot-assisted excision of myxoma using subendothelial excision through left atrial approach only.
METHODS: From November 2003 to May 2013, we operated 39 patients with left atrial myxoma. One patient had recurred myxoma who received mass excision 3 years ago. Male vs female ratio was 18:21 and mean age was 62.0±11.9 (40-86) years old. Among them, 30 patients received conventional operation (group C) and 9 patients received robot-assisted excision (group R). In robotic surgery, we performed bi-atrial approach in 3 and subendothelial approach with left atrial only in 6. Remaining stalk area was electrocauterized.
RESULTS: In group C, cardiopulmonary bypass and aortic cross clamping times were 71±24 (31-125) and 48±17 (15-77) minutes, respectively. In group R, those were 136±32 (103-204) and 77±24 (54-132) minutes, respectively(P<0.05). Total operation time (from skin incision to sutures) was 182±39 (90-267) minutes in group C and 275±59 (218-386) minutes in group R(P<0.05). There is no operative mortality. One patient in group R received bleeding control for hepatic laceration. Hospital stay was 10.6±9.5 (4-44)days in group C and 6.7±2.7 (4-11) days in group R(P=0.23). During 30.9±26.1 (1-118) months follow-up, there were two follow-up loss. However, late mortality or recurrence did not occurred yet.
CONCLUSIONS: Excision of left atrial myxoma shows good long-term results. Endothelial excision through left atrial approach is feasible and effective in robot-assisted cardiac surgery. Further study is mandatory to prove long-term benefit in terms of recurrence.