Robotic-assisted cardiac surgery: anesthetic and postoperative considerations.
OBJECTIVE
To assess the feasibility of endoscopic telemanipulated cardiac surgery and describe the anesthetic, postoperative, and surgical implications of minimally invasive robotic-assisted cardiac surgery.


METHODS
Prospective study.


METHODS
Cardiovascular and transplant center, university hospital.


METHODS
Twenty patients (13 men, 7 women) scheduled for either coronary artery bypass graft surgery or valve surgery. Mean age was 53 +/- 5 years (range, 31 to 75 years) and mean New York Heart Association class was 2.4. Three patients (6 %) were having redo procedures, and 1 patient had bacterial endocarditis.


METHODS
Surgery was done with the aid of the daVinci surgical robot (Intuitive Surgical, Mountain View, CA). Induction and maintenance of anesthesia consisted of a target-controlled infusion of remifentanil and propofol. In 11 cases (55%), cardiopulmonary bypass was performed with Port-Access technology (Heartport, Redwood City, CA), and in the remaining 9 cases (45%), conventional femorofemoral bypass was used.


RESULTS
Fifteen patients (75 %) were extubated within 6 hours and discharged from the cardiac surgery intensive care unit on postoperative day 1. Two patients (10%) were reexplored in the immediate postoperative period. Two conversions to thoracotomy were reported. One reoperation at 6 months and 1 late death occurred. At 1-year follow-up, excellent functional results were observed in 18 cases.


CONCLUSIONS
Caution should be used when assessing innovative medical-surgical techniques. Despite technical difficulties and lengthy procedures, results were satisfactory. The feasibility of robotic-assisted surgery for coronary artery bypass graft and valve procedures is intuitively appealing.
D'Attellis
Nicola
N
Department of Anesthesiology and Critical Care, Broussais Hospital. Nicola.D-Attellis@hop.egp.ap-hop.paris.fr
Loulmet
Didier
D
Carpentier
Alain
A
Berrebi
Alain
A
Cardon
Cyril
C
Severac-Bastide
Renaud
R
Fabiani
Jean-Noel
JN
Safran
Denis
D
D000328:Adult; D000368:Aged; D000758:Anesthesia; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome