Robotic ASD closure : The initial experience

Introduction Advances in technology have spurred innovations in most surgical disciplines- including cardiac surgery directed towards minimizing invasiveness without compromising outcomes. We present our initial experience and learning curve difficulties in performing robotically assisted atrial septal defect closure in an adult population. Patients and methods Over a 4 year period between February 2008 to January 2012, we operated upon 52 patients with secundum type of Atrial Septal Defect (ASD), using the daVinci robotic system. All operations were done with peripheral cardiopulmonary bypass and direct transthoracic access to aorta for cardioplegia and aortic cross clamping. Mean age of patients was 26.8 years, mean cross-clamp, cardiopulmonary bypass and operating times were 68.4, 121.6 and 178.44 min respectively. In 4 patients, there was conversion - to sternotomy in three and to thoracotomy in one. In all patients, successful closure was confirmed by Trans Esophageal Echocardiography (TEE). Mean Intensive Care Unit (ICU) stay duration was 22.1 h and hospital stay 3.6 days. There was no mortality. In one patient, there was lung parenchymal bleeding necessitating reexploration followed by persistent air leak for 48 h. Conclusions Robotic telemanipulation enables application of endoscopic technology to performing complex intrathoracic operations safely. Patients with simple lesions like ASD who are not candidates for device closure may be offered this surgeon-friendly technology to avoid possible complications of sternotomy and enable faster recovery. Factors like - adapting to telemanipulation, setting up peripheral cardiopulmonary bypass and restricted visibility prolongs both operating times and surgeons' learning curve but greatly minimises patient morbidity.