RESUMO
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.
Assuntos
Cisto Mediastínico , Procedimentos Cirúrgicos Robóticos , Endoscopia , Humanos , Tempo de Internação , Cisto Mediastínico/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/métodosRESUMO
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.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Robótica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento , Adulto JovemRESUMO
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.
Assuntos
Fibrilação Atrial , Cardiopatias Congênitas , Comunicação Interatrial , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral , Revascularização Miocárdica , Pericárdio , Robótica , Cirurgia TorácicaRESUMO
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.
Assuntos
Cardiopatias/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adolescente , Adulto , Idoso , Brasil , Ponte Cardiopulmonar/métodos , Feminino , Cardiopatias/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto JovemRESUMO
OBJETIVO: Demonstrar as possibilidades da utilização da videotoracoscopia na cirurgia cardíaca com circulação extracorpórea (CEC). MÉTODOS: Entre fevereiro de 2006 e novembro de 2008, 102 pacientes foram submetidos consecutivamente a cirurgia cardíaca minimamente invasiva videoassistida. As doenças cardíacas abordadas foram valvopatia mitral (n=56), aórtica (n=14), comunicação interatrial (n=32), seis pacientes apresentavam insuficiência tricúspide associada e do grupo total, doze tinham fibrilação atrial. A idade variou de 18 a 68 anos, sendo 57 pacientes do sexo feminino. O método cirúrgico constou de canulação arterial e venosa femoral, incisão de quatro a seis centímetros (cm) ao nível do 3º ou 4º espaço intercostal direito (EICD), dependendo da doença do paciente, entre as linhas axilar anterior e hemiclavicular direita, sulco mamário ou periareolar direita e toracoscopia. RESULTADOS: Os procedimentos cirúrgicos compreenderam: plastia (n=20) ou troca valvar mitral (n=36); troca valvar aórtica (n=14); atriosseptoplastia com remendo de pericárdio bovino (n=32); plastia valvar tricúspide com anel rígido (n=6); e correção cirúrgica da fibrilação atrial por radiofrequência (n=12). Todas as cirurgias foram realizadas sem intercorrências. Não houve conversão para toracotomia. Dois pacientes evoluíram com fibrilação atrial no pós-operatório. Houve um (0,9 por cento) episódio de acidente vascular cerebral, sete dias após a alta hospitalar, e um óbito (0,9 por cento) decorrente de síndrome da resposta inflamatória sistêmica (SIRS). CONCLUSÃO: Este trabalho demonstra a abrangência de afecções possíveis de serem abordadas pela videocirurgia cardíaca com CEC, sendo um procedimento seguro, eficaz e com baixa morbidade e mortalidade. A cirurgia cardíaca minimamente invasiva videoassistida já é uma realidade no Brasil, demonstrando excelentes resultados estéticos e funcionais
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 3º or 4º 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 percent) 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
