title: Totally endoscopic atrial septal defect closure using robotic techniques: report of two cases.
abstract: BACKGROUND
  The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. We report 2 cases of totally endoscopic atrial septal defect (ASD) closure using a robotic system. Open-heart closure of an ASD without opening the chest has never been previously reported.
  
  
  METHODS
  Following percutaneous cannulation for cardiopulmonary bypass, aortic occlusion and delivery of cardioplegia, 2 patients with an ASD were successfully operated on using a robotic surgical device. After exclusion of the right lung, two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax. A fourth port was inserted for an accessory endoscopic instrument. The ASD closure was carried out with interrupted stitches in one case and with a continuous suture in the other.
  
  
  RESULTS
  Cardiopulmonary bypass and cardioplegic arrest times were respectively 130 and 75 min in the first and 87 and 60 min in the second case. Extubation was carried out 3 and 5 hours postoperatively. Both patients resumed a totally normal lifestyle 1 week after the operation.
  
  
  CONCLUSIONS
  Totally endoscopic open-heart ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and excellent cosmetic results. This modality of treatment can be considered an alternative to the transcatheter closure of ASD.
authors.affiliation: Division of Cardiac Surgery, San Raffaele Hospital, Milan, Italy. Lucia.Torracca@hsr.it
authors.forename: L
authors.initials: L
authors.lastname: Torracca
authors.forename: G
authors.initials: G
authors.lastname: Ismeno
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D005260:Female; D006322:Heart Aneurysm / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*