Totally endoscopic robotic ventricular septal defect repair in the adult.
OBJECTIVE
We have previously reported total endoscopic ventricular septal defect repair in the adult using the da Vinci S Surgical System. The optimal results encouraged us to extend the use of this technology to more complicated patients with ventricular septal defect.


METHODS
From January 2009 to July 2010, 20 patients underwent total endoscopic robotic ventricular septal defect repair. The average patient age was 29.0 ± 9.5 years (range, 16-45). Of the 20 patients, 9 were female and 11 were male. The echocardiogram demonstrated that the average diameter of the ventricular septal defect was 6.1 ± 2.8 mm (range, 2-15), and 4 patients had concomitant patent foramen ovale. Ventricular septal defect closure was directly secured with interrupted mattress sutures in 14 patients and patched in 6 patients. All the procedures were completed using the da Vinci robot by way of 3 port incisions and a 2.0- to 2.5-cm working port in the right side of the chest.


RESULTS
All patients were operated on successfully. The mean cardiopulmonary bypass and mean crossclamp time was 94.3 ± 26.3 minutes (range, 70-140) and 39.1 ± 12.9 minutes (range, 22-75), respectively. The mean operation time was 225.0 ± 34.8 minutes (range, 180-300). The postoperative transesophageal echocardiogram demonstrated an intact ventricular septum. No residual left-to-right shunting and no permanently complete atrioventricular dissociation was found postoperatively. The mean hospital stay was 5 days. No residual shunt was found during a mean follow-up of 7 months (range, 1-22). The patients returned to normal function within 1 week without any complications.


CONCLUSIONS
Total endoscopic robotic ventricular septal defect repair in adult patients is feasible, safe, and efficacious.
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing, China. gaochq301@yahoo.com
Changqing
C
Gao
Ming
M
Yang
Gang
G
Wang
Cangsong
C
Xiao
Jiali
J
Wang
Yue
Y
Zhao
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012371:Robotics; D025321:Surgery, Computer-Assisted; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult