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Establishment Of Robotic Cardiac Surgery-the First 150 Cases
Franziska Hüther, Adrian Ursulescu, Nora Göbel, Melisa Ortega-Gaviria, Mihnea Ghinescu, Gernot Hipp, Dominik Bierbaum, Ulrich Franke.
Robert- Bosch- Krankenhaus, Stuttgart, Germany.
BACKGROUND: A cardiac robotic program has been established in only few centres worldwide. Despite of excellent results published, there is a controversial discussion about the cost effectiveness and the technical demands. This study should analyse results regarding safety and learning curve of the initial establishment phase.
METHODS: The first 150 robotic supported cases operated on between July 2019 and November 2020 were analysed regarding time consumption, complications and outcome. Only two surgeons supported by a defined OR-team of four table assistants and three scrub nurses had done the operations. Coronary anastomoses have been executed using minithoracotomy due to the lack of an available robotic stabilizer system.
RESULTS: In OPCAB patients with more than one distal anastomoses additional RITA was used in 27 cases and the mean number of distal anastomoses was 2. Concomitant procedures during MVR were TVR (15), MAZE-IV(3), PVI (22), LAA closure (29), ASD closure (3) and myxoma resection (2). There was no 30-day mortality. The average OR times are shown in table 1. We could observe a stiff learning curve for every kind of operation with an equalization of the relevant times compared to the minimally invasive non robotic counterparts.
CONCLUSIONS:The Da Vinci robotic System allows very safe operations and a stiff learning curve even during the initial establishment phase.
| Type of operation | n | OR time in min (mena) | CPB time in min (mena) | X- clamp in min (mean) | Stroke | Death | ICU stay in h (median) | Hospital stay in d (median) |
| MIDCAB | 21 | 164,6 | 0 | 0 | 0 | 0 | 10 | 5 |
| OPCAB | 34 | 257,5 | 0 | 0 | 0 | 0 | 17,5 | 6 |
| MVR | 83 | 242,1 | 188,5 | 99,1 | 1 | 0 | 22 | 6 |
| TVR | 2 | 206,0 | 162,0 | 0 | 0 | 0 | 22 | 8 |
| ASD | 3 | 225,6 | 148,3 | 60,6 | 0 | 0 | 23 | 8 |
| Myxoma | 6 | 149,3 | 102,0 | 29,3 | 0 | 0 | 22 | 5 |
| Isolated MAZE IV | 1 | 230 | 180 | 55 | 0 | 0 | 23 | 5 |
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