title: Totally thoracoscopic closure of ventricular septal defect without a robotically assisted surgical system: a summary of 119 cases.
abstract: OBJECTIVE
  To summarize the clinical outcomes of totally thoracoscopic closure of a ventricular septal defect (VSD).
  
  
  METHODS
  Totally thoracoscopic VSD closure was performed in 119 patients (66 boys; mean age, 7.1 ± 3.6 years). An additional 35 patients undergoing open-chest VSD closure were selected as a control group. Using 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and VSD closure were performed by thoracoscopy without the aid of a robotically assisted surgical system.
  
  
  RESULTS
  Cardiopulmonary bypass and aortic crossclamp times were 42.2 ± 9.8 and 32.5 ± 7.3 minutes, respectively. There were no deaths but 1 patient required insertion of a permanent pacemaker as a result of postoperative atrioventricular conduction block. The length of stay in the intensive care unit (11.0 ± 2.6 vs 22.9 ± 4.9 hours, P < .01) or postoperative hospital stay (4.2 ± 1.1 vs 6.6 ± 2.1 days, P < .03) in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (31.9% vs 74.2%, P < .001). Rate of blood transfusion during the operation (17.6% vs 65.7%, P = .001) and the postoperative use of opioid analgesics (31.9% vs 74.3%, P = .003) in the thoracoscopic group was lower than in the control group. Transesophageal echocardiographic analysis 4.6 ± 2.3 months after the operation showed complete closure of the defect.
  
  
  CONCLUSIONS
  Totally thoracoscopic closure of VSD through a 3-port entry was safe and effective.
authors: Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China. Electronic address: mazengshan31@163.com.
authors: Zeng-Shan
authors: ZS
authors: Ma
authors: Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China.
authors: Chang-Yong
authors: CY
authors: Yang
authors: Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China.
authors: Ming-Feng
authors: MF
authors: Dong
authors: Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China.
authors: Shu-Ming
authors: SM
authors: Wu
authors: School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China. Electronic address: lwang@csu.edu.au.
authors: Le-Xin
authors: LX
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000209:etiology / Q000628:therapy; D001803:Blood Transfusion; D001835:Body Weight; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002681:China; D017548:Echocardiography, Transesophageal; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D018579:Patient Selection; D010492:Pericardiectomy; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid