Interactive CardioVascular and Thoracic Surgery 9 (2009) 500–505 www.icvts.org
State-of-the-art - Cardiac general
Robot-assisted cardiac surgery
Paul Modi, Evelio Rodriguez, W. Randolph Chitwood Jr.*
East Carolina Heart Institute, East Carolina University, Pitt County Memorial Hospital, 600 Moye Boulevard, Greenville, NC 27834, USA Received 10 February 2009; received in revised form 5 June 2009; accepted 7 June 2009
Recognition of the significant advantages of minimizing surgical trauma has resulted in a substantial increase in the number of minimally invasive (MI) cardiac surgical procedures being performed. Synchronously, technological advances in optics, instrumentation and perfusion technology have facilitated routine totally endoscopic robotic cardiac surgery using the da Vinci telemanipulation system (Intuitive Surgical Inc). This technology has been applied to many cardiac surgical procedures, in particular, mitral valve repair (MVP) and totally endoscopic coronary artery bypass grafting (TECAB), allowing the surgeon to operate through 5 mm port sites rather than a traditional median sternotomy. In this rapidly evolving field, we review the clinical results of robotic cardiac surgery. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Keywords: Surgical procedures; Minimally invasive; Thoracic surgery; Video-assisted; Robotics; Telemedicine yinstrumentation
During the past decade, recognition of the significant
advantages of minimizing surgical trauma by reducing incision size and eliminating rib-spreading have resulted in a substantial increase in the number of minimally invasive
(MI) cardiac surgical procedures being performed. These
benefits have included less pain, shorter hospital stays,
faster return to normal activities and improved cosmesis
w1x. At the same time, improvements in surgical instrumentation, perfusion technology and visioning platforms have facilitated these advances such that MI approaches have
now become the standard of care at certain institutions
worldwide due to excellent results. Endoscopic instrumentation, with only four degrees of freedom, significantly reduces the dexterity needed for delicate cardiac surgical
procedures, and the loss of depth perception by using twodimensional video monitors further increases operative difficulty. Robotic surgery provides a solution to these
problems and represents a paradigm shift in the delivery
of healthcare for both the patient and the surgeon.
Robotic systems consist of telemanipulators where endeffectors, or micro-instruments, are controlled remotely from a console. The da Vinci S system (Intuitive Surgical,
Mountain View, CA, USA) is the most widely used and is
comprised of a surgeon console, an instrument cart and a
visioning platform. The operative console allows the surgeon to immerse himself into the operative field through high-definition three-dimensional imaging. Finger and wrist
movements are registered through sensors and translated
into motion-scaled tremor-free movements avoiding the
*Corresponding author. Tel.: q1 252 744 4822; fax: q1 252 744 3051. E-mail address: firstname.lastname@example.org (W.R. Chitwood Jr.).
2009 Published by European Association for Cardio-Thoracic Surgery
fulcrum effect and instrument shaft shear forces common
to long-shafted endoscopic instruments. Wrist-like articulations at the ends of micro-instruments bring the pivoting action of the instrument to the plane of the operative field improving dexterity in tight spaces and allowing truly
ambidextrous suture placement.
The greatest growth in robotic procedures has been in
the field of urology with rapid dissemination of robotassisted radical prostatectomy worldwide. Currently, over 1700 robotic cardiac operations are performed in the USA
per year but with a yearly increase of about 400 cases, or
about 25% growth per...