Totally endoscopic atrial septal defect closure with a robotic system: experience with seven cases

Background: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. The introduction of the robotic systems can further reduce the surgical trauma and improve the surgical dexterity. We report seven cases of complete closed chest atrial septal defect closure using the "da Vinci"(TM) Surgical System ( Intuitive Surgical, Mountain View, CA). Methods: Following peripheral cannulation for cardiopulmonary bypass (CPB), aortic occlusion and cardioplegia delivery, five patients with atrial septal defect (ASD) and two patients with patent forame ovale (PFO) with atrial septal aneurysm (ASA) were successfully treated using the robotic system. Two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax and an accessory port was placed for blood suction and ancillary instruments insertion. The defect closure was carried out with interrupted stitches in one patient and with a continuous suture in the others. Results: Mean cardiopulmonary bypass and cross clamp time were 101.8 +/- 39.6 and 63.4 +/- 21.9 minutes respectively. Extubation was carried out within the seventh postoperative hour. All patients returned to normal lifestyle in one week. Conclusion: Complete closed chest ASD closure can be carried out using robotic technique with rapid postoperative recovery and excellent cosmetic result.