Technical aspects of a totally endoscopic, robotic-assisted pericardial cyst resection.

A pericardial cyst is a rare mediastinal mass, often diagnosed as an incidental finding. Symptomatic patients or those with suspicion of malignancy may warrant surgical resection. In this video tutorial, we demonstrate the technical aspects of a totally endoscopic robotic-assisted pericardial cyst resection. This approach allows for definitive treatment through a safe procedure, with a small surgical wound, short in-hospital stay, a fast recovery, and almost no postoperative limitations.

Three-Dimensional Printing in Minimally Invasive Cardiac Surgery: Optimizing Surgical Planning and Education with Life-Like Models.

Over recent years, the surgical community has demonstrated a growing interest in imaging advancements that enable more detailed and accurate preoperative diagnoses. Alongside with traditional imaging methods, three-dimensional (3-D) printing emerged as an attractive tool to complement pathology assessment and surgical planning. Minimally invasive cardiac surgery, with its wide range of challenging procedures and innovative techniques, represents an ideal territory for testing its precision, efficacy, and clinical impact. This review summarizes the available literature on 3-D printing usefulness in minimally invasive cardiac surgery, illustrated with images from a selected surgical case. As data collected demonstrates, life-like models may be a valuable adjunct tool in surgical learning, preoperative planning, and simulation, potentially adding safety to the procedure and contributing to better outcomes.

Three-Dimensional Printing in Minimally Invasive Cardiac Surgery: Optimizing Surgical Planning and Education with Life-Like Models

Abstract Over recent years, the surgical community has demonstrated a growing interest in imaging advancements that enable more detailed and accurate preoperative diagnoses. Alongside with traditional imaging methods, three-dimensional (3-D) printing emerged as an attractive tool to complement pathology assessment and surgical planning. Minimally invasive cardiac surgery, with its wide range of challenging procedures and innovative techniques, represents an ideal territory for testing its precision, efficacy, and clinical impact. This review summarizes the available literature on 3-D printing usefulness in minimally invasive cardiac surgery, illustrated with images from a selected surgical case. As data collected demonstrates, life-like models may be a valuable adjunct tool in surgical learning, preoperative planning, and simulation, potentially adding safety to the procedure and contributing to better outcomes.

Periareolar Access for Minimally Invasive Cardiac Surgery: The Brazilian Technique.

The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.

Robotic cardiac surgery in Brazil.

BACKGROUND: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. RESULTS: The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. CONCLUSIONS: Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

Robotic surgery in cardiology: a safe and effective procedure.

OBJECTIVE: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. METHODS: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. RESULTS: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. CONCLUSION: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.

Cirurgia robótica em Cardiologia: um procedimento seguro e efetivo / Robotic surgery in Cardiology: a safe and effective procedure

OBJETIVO: Avaliar os resultados em curto e médio prazo dos pacientes submetidos à cirurgia cardíaca minimamente invasiva robô-assistida. MÉTODOS: De março de 2010 a março de 2013, 21 pacientes foram submetidos à cirurgia cardíaca robô-assistida. Os procedimentos realizados foram: plastia valvar mitral, troca valvar mitral, cirurgia de correção da fibrilação atrial, correção cirúrgica da comunicação interatrial, ressecção de tumor intracardíaco, revascularização do miocárdio totalmente endoscópica e pericardiectomia. RESULTADOS: A idade média foi de 48,39±18,05 anos. O tempo médio de circulação extracorpórea foi de 151,7±99,97 minutos, e o tempo médio de pinçamento aórtico foi de 109,94±81,34 minutos. O tempo médio de intubação orotraqueal foi de 7,52±15,2 horas, sendo que 16 (76,2%) pacientes foram extubados ainda em sala operatória, imediatamente após o procedimento. O tempo médio de permanência em unidade de terapia intensiva foi de 1,67±1,46 dias. Não houve conversões para esternotomia. Não houve óbito intra-hospitalar ou mesmo durante o seguimento em médio prazo dos pacientes. A média do tempo de acompanhamento dos pacientes foi de 684±346 dias, variando de 28 dias a 1096 dias. CONCLUSÃO: A cirurgia cardíaca robô-assistida mostrou-se exequível, segura e efetiva, podendo ser aplicada na correção de diversas patologias intra e extracardíacas.

OBJECTIVE: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. METHODS: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. RESULTS: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. CONCLUSION: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.

Randomised, controlled study of preoperative electroacupuncture for postoperative pain control after cardiac surgery.

BACKGROUND: This study aims to evaluate the effects of preoperative electroacupuncture (EA) on the need for opioids in the postoperative stage of conventional cardiac surgery. METHODS: A prospective, randomised and controlled study was conducted at Unimed Hospital Centre in Joinville, SC, Brazil. The day before the surgery, 32 patients undergoing cardiac surgery were randomised into two groups: patients from the treatment group received preoperative EA at bilateral points (LI4-LI11, LR3-ST36, PC6-TE5) for 30 min with alternating frequencies of 3 and 15 Hz. Patients from the control group received sham transcutaneous electrical nerve stimulation (TENS). Use of fentanyl during the postoperative period was measured. RESULTS: 10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group. The average total doses of fentanyl given were 13.1±2.2 and 16.3±1.6 µg/kg in the treatment and control groups respectively (p<0.002). The doses of patient controlled analgesia were 4.1±2.0 and 6.9±1.7 µg/kg in the treatment and control groups respectively (p<0.003). The number of boluses issued also differed (treatment 13.9±7.0 vs control 24.8±7.0, p<0.002). Pain intensity scores differed between the groups (treatment 2.5±1.1 vs control 4.0±2.0, p<0.04). One patient from the control group experienced drowsiness that justified a change in fentanyl infusion, as decided by the anaesthetist. CONCLUSION: Preoperative electro-acupuncture in conventional cardiac surgery may reduce the postoperative consumption of fentanyl.

Video-assisted cardiac surgery: results from a pioneer project in Brazil.

OBJECTIVE: To demonstrate the possibilities of the use of videothoracoscopy in cardiac surgery using cardiopulmonary bypass (CPB). METHODS: Between February 2006 and November 2008, 102 patients underwent consecutively minimally invasive video-assisted cardiac surgery. The cardiac pathologies approached were: mitral valvopathy (n=56), aortic (n=14), interatrial communication (IC) (n=32), six patients presented associated tricuspid insufficiency and 12 presented atrial fibrillation. The age ranged from 18 to 68 years and 57 were female. The surgical approach was: femoral arterial and venous cannulation, minithoracotomy ranging from four to six centimeters (cm) at the level of the 3 degrees or 4 degrees right intercostal space (RICS), depending on the pathology of the patient, between anterior axillary line and hemiclavicular line, submammary or right periareolar groove through the right breast and thoracoscopy. RESULTS: The surgical procedures were: plasty (n=20) or mitral valve replacement (n=36), aortic valve replacement (n=14), atrioseptoplasty using pericardial patch (n=32), tricuspid valve repair with rigid ring (n=6) and surgical correction of atrial fibrillation with radiofrequency (n=12). There were no complications during the procedures. There was no conversion to thoracotomy in neither case. Two patients developed atrial fibrillation in the postoperative period. There was an episode of stroke seven days after the hospital discharge and one death (0.9%) due to systemic inflammatory response syndrome (SIRS). CONCLUSION: This study demonstrates the coverage of pathologies that are possible to be approached by video-assisted cardiac surgery with cardiopulmonary bypass being a safe and effective procedure with low morbimortality. Minimally invasive video-assisted cardiac surgery is already a reality in Brazil, demonstrating excellent aesthetic and functional results.