title: Robotic cardiac surgery in Brazil.
abstract: BACKGROUND
  Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci®robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil.
  
  
  METHODS
  From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy.
  
  
  RESULTS
  The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term.
  
  
  CONCLUSIONS
  Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Robinson
authors.initials: R
authors.lastname: Poffo
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Alisson P
authors.initials: AP
authors.lastname: Toschi
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Renato B
authors.initials: RB
authors.lastname: Pope
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Paola K
authors.initials: PK
authors.lastname: Montanhesi
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Ricardo S
authors.initials: RS
authors.lastname: Santos
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Teruya
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Dina M
authors.initials: DM
authors.lastname: Hatanaka
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Gabriel F
authors.initials: GF
authors.lastname: Rusca
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Claudio H
authors.initials: CH
authors.lastname: Fischer
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Vieira
authors.affiliation: Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Makdisse
keywords: Coronary artery bypass; Minimally invasive surgery; atrial septal defect; robotic surgery; valve surgery