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Left Atrial Approach For Robotic Atrial Septal Defect Repair
Douglas Overbey, MD, Cathlyn Medina, Berk Aykut, Joseph Turek, Don Glower;
Duke University, Durham, NC, USA
BACKGROUND: Robotic surgical techniques have significantly grown within the cardiac surgery field, particularly among patients with congenital heart disease (CHD). This trend is reflective of a broader shift in the surgical community towards less invasive procedures. Improved cosmesis, shorter hospital stays, and reduced postoperative pain are particularly important for the younger CHD patient population. While robotic repair of atrial septal defects (ASD) offers high success and low complication rates, only a few centers currently perform the procedure. Here, we describe our ASD repair using a left atrial approach to facilitate visualization and venting.
METHODS: Using recorded footage from the operating room, we describe our approach to a robotic ASD closure using the Intuitive daVinci Surgical System. Through this video, we highlight critical intraoperative steps of our surgical approach.
RESULTS: The procedure was performed through a 2-4cm right lateral thoracotomy with additional 8mm ports. Cardiopulmonary bypass was initiated via peripheral cannulation. The heart was fibrillated and a left atriotomy was performed to visualize the septal defect. This approach allows consistent venting of the left ventricle throughout the case, and deairing at conclusion. The visualization with a left atrial approach also allows easier suturing of the patch and identification of anatomy. Native pericardium was used for repair. The patient was weaned from bypass and a transesophageal echocardiogram demonstrated no residual ASD.
CONCLUSIONS: Since the inception of our robotic ASD program, 11 patients have successfully undergone ASD closure with excellent outcomes over the period of one year. The left atrial approach offers additional protection against air entrainment and distention while performing the repair with fibrillation. This technique results in improved cosmesis and allows for early return to activity in appropriately selected patients.
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