Overview of robotic cardiac surgery

Abstract

It has been the dream of cardiac surgeons to perform cardiac procedures in the closed chest that would offer patients the same benefits as those that open-incision procedures do. The revolutionary minimally invasive surgery has certainly satisfied some of the desires of cardiac surgeons but they have never been as satisfactory as what cardiac surgical robots can ever have been. Minimally invasive cardiac surgery has grown in popularity over the past two decades. And minimally invasive videoscope has been the most used approach. Minimally invasive techniques can provide patients with more advantages in recovery process than open procedures. The 2-D camera of endoscope causes impaired visualization, absence of the depth of the surgical field, and difficulty for complete precise manipulation by surgeons. The drive for robotic surgery is rooted in the desire to overcome the shortcomings of endoscopic surgery and expand the benefits. Robotic technology was introduced into the cardiac surgical field in 1998. AESOP (Automated Endoscopic System for Optimal Positioning) and ZEUS, two surgical robotic systems, were approved by the FDA for clinical use in 1994 and 2001 respectively. In January 1999, Intuitive launched the da Vinci Surgical System, and in 2000, it became the first robotic surgical system cleared by the FDA for general laparoscopic surgery. In the following years, the FDA cleared the da Vinci Surgical System for cardiac procedures. The robotic technique has been successfully used in atrial septal defect repair on arrest or beating heart, mitral valve repair or replacement, coronary bypass graft, myxomas resection, atrial fibrillation ablation, left ventricular epicardial lead placemen and aortic surgery. Early results are encouraging with evidence that patients experience little blood transfusion, shorter hospital stay, sooner return to preoperative function levels and improve quality of life with robotic surgery than with sternotomy. However, long-term results are needed to determine if robotic techniques could become the new standards in cardiac surgery.