Totally endoscopic atrial septal repair with or without robotic assistance: a systematic review and meta-analysis of case series.
OBJECTIVE
To evaluate the safety and efficacy of totally endoscopic repair of atrial septal defect (ASD).


METHODS
A review of the literature was conducted. Studies were obtained from the following sources: MEDLINE, EMBASE, Web of Science and CENTRAL Library. Inclusion criteria were: (1) randomised controlled trials, non-randomised trials, observational studies, case series, and full text conference proceedings; (2) use of totally endoscopy closure of ASD; and (3) outcomes reported as clinical efficacy. When available, we also quantified the complication rates from each included study. Meta-analysis was performed on outcomes with a random-effects model.


RESULTS
Six studies met all inclusion criteria. The pooled average success rate of totally endoscopic ASD repair was 94.8% from a total of 114 cases (95% CI, 88.0% to 97.8%), with a minimal heterogeneity in the group of studies (Q value x(2)=1.807, I(2)=0.000). In the studies with no robotic assistance, an average success rate of totally endoscopic ASD repair was 96.9% (95% CI, 85.9-99.4%), with a minimal heterogeneity in the two studies (Q value x(2)=0.683, I(2)=0.000). There were few complications for totally endoscopic ASD repair in the studies with and without robotic assistance. There were no statistically significant differences in success rates between robotically and non-robotically assisted totally endoscopic repairs (p>0.05).


CONCLUSIONS
Totally endoscopic ASD repair was associated with a high success rate and a low complication rate. There is a need for prospective controlled clinical trials comparing totally endoscopic and conventional surgical repair of ASD.
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
Dao-Kuo
DK
Yao
Hui
H
Chen
Long-Le
LL
Ma
Zeng-Shan
ZS
Ma
Le-Xin
LX
Wang
D002986:Clinical Trials as Topic; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000628:therapy*; D006801:Humans; D016239:MEDLINE; D008297:Male; D012371:Robotics / Q000379:methods*