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The role of robotics in cardiac surgery: a systematic review

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Abstract

The application of robotic technologies in cardiac surgery has provided the possibility for minimally invasive access inside the thorax and avoidance of a median sternotomy. Given that current evidence seems promising, we sought to systematically review the existing literature regarding the efficacy, feasibility and mortality rate associated with robotic cardiac surgery. The PubMed and Cochrane bibliographical databases were thoroughly searched for the following MeSH terms: “robotic”, “cardiac surgery” and “heart surgery”. Original studies on robotic cardiac surgery in more than ten cases and reporting on the associated peri- or post-operative mortality were deemed eligible. Twenty-eight studies were included and provided data for 5993 patients with a mean age of 59.8 years. Approximately, one out of two patients (49.2%) underwent robotic CABG, while the other half (49.9%) underwent robotic MVR. Robotic atrial septal defect repair and atrial tumor resection were performed in a small proportion (0.9%) of the patients. Mean 30-day mortality was 0.7% ranging from 0 to 0.8% among the different types of surgery, while late mortality was 0.8% ranging from 0 to 1% with a mean follow-up period of 40.1 months. Our findings demonstrate that the application of robotics in cardiac surgery has provided a safe and efficacious alternative to the traditional techniques. However, more trials are necessary to elucidate all of its aspects.

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References

  1. Yanagawa F, Perez M, Bell T et al (2015) Critical outcomes in nonrobotic vs robotic-assisted cardiac surgery. JAMA Surg 150:771–777. https://doi.org/10.1001/jamasurg.2015.1098

    Article  PubMed  Google Scholar 

  2. Pettinari M, Navarra E, Noirhomme P, Gutermann H (2017) The state of robotic cardiac surgery in Europe. Ann Cardiothorac Surg 6:1–8. https://doi.org/10.21037/acs.2017.01.02

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang S, Zhou J, Cai J-F (2014) Traditional coronary artery bypass graft versus totally endoscopic coronary artery bypass graft or robot-assisted coronary artery bypass graft—meta-analysis of 16 studies. Eur Rev Med Pharmacol Sci 18:790–797

    PubMed  CAS  Google Scholar 

  4. Seco M, Cao C, Modi P et al (2013) Systematic review of robotic minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2:704–716. https://doi.org/10.3978/j.issn.2225-319X.2013.10.18

    Article  PubMed  PubMed Central  Google Scholar 

  5. de Cannière D, Wimmer-Greinecker G, Cichon R et al (2007) Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: multicenter European experience. J Thorac Cardiovasc Surg 134:710–716. https://doi.org/10.1016/j.jtcvs.2006.06.057

    Article  PubMed  Google Scholar 

  6. Dogan S, Aybek T, Andressen E et al (2002) Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovasc Surg 123:1125–1131

    Article  PubMed  CAS  Google Scholar 

  7. Kappert U, Cichon R, Schneider J et al (2000) Robotic coronary artery surgery—the evolution of a new minimally invasive approach in coronary artery surgery. Thorac Cardiovasc Surg 48:193–197. https://doi.org/10.1055/s-2000-6904

    Article  PubMed  CAS  Google Scholar 

  8. Roubelakis A, Casselman F, van der Merwe J et al (2017) Robotic-enhanced coronary surgery in octogenarians. Interact Cardiovasc Thorac Surg 24:384–387. https://doi.org/10.1093/icvts/ivw369

    Article  PubMed  Google Scholar 

  9. Jegaden O, Wautot F, Sassard T et al (2011) Is there an optimal minimally invasive technique for left anterior descending coronary artery bypass? J Cardiothorac Surg 6:37. https://doi.org/10.1186/1749-8090-6-37

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kesävuori R, Raivio P, Jokinen JJ et al (2017) Early experience with robotic mitral valve repair with intra-aortic occlusion. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2017.10.076

    Article  PubMed  Google Scholar 

  11. Navarra E, Mastrobuoni S, De Kerchove L et al (2017) Robotic mitral valve repair: a European single-centre experience. Interact Cardiovasc Thorac Surg 25:62–67. https://doi.org/10.1093/icvts/ivx060

    Article  PubMed  Google Scholar 

  12. Folliguet T, Vanhuyse F, Constantino X et al (2006) Mitral valve repair robotic versus sternotomy. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 29:362–366. https://doi.org/10.1016/j.ejcts.2005.12.004

    Article  Google Scholar 

  13. Autschbach R, Onnasch JF, Falk V et al (2000) The Leipzig experience with robotic valve surgery. J Card Surg 15:82–87

    Article  PubMed  CAS  Google Scholar 

  14. Bonaros N, Schachner T, Oehlinger A et al (2006) Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg 82:687–693. https://doi.org/10.1016/j.athoracsur.2006.03.024

    Article  PubMed  Google Scholar 

  15. Hemli JM, Darla LS, Panetta CR et al (2012) Does body mass index affect outcomes in robotic-assisted coronary artery bypass procedures? Innov Phila Pa 7:350–353. https://doi.org/10.1097/IMI.0b013e31827e1ea9

    Article  Google Scholar 

  16. Gillinov AM, Mihaljevic T, Javadikasgari H et al (2018) Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg 155:82–91.e2. https://doi.org/10.1016/j.jtcvs.2017.07.037

    Article  PubMed  Google Scholar 

  17. Murphy DA, Moss E, Binongo J et al (2015) The expanding role of endoscopic robotics in mitral valve surgery: 1257 consecutive procedures. Ann Thorac Surg 100:1675–1681. https://doi.org/10.1016/j.athoracsur.2015.05.068 (discussion 1681–1682)

    Article  PubMed  Google Scholar 

  18. Bhamidipati CM, Mehta GS, Sarwar MF et al (2010) Robot-assisted mitral valve repair: a single institution review. Innov Phila Pa 5:295–299. https://doi.org/10.1097/IMI.0b013e3181ed5103

    Article  Google Scholar 

  19. Tatooles AJ, Pappas PS, Gordon PJ, Slaughter MS (2004) Minimally invasive mitral valve repair using the da Vinci robotic system. Ann Thorac Surg 77:1978–1982. https://doi.org/10.1016/j.athoracsur.2003.11.024 (discussion 1982–1984)

    Article  PubMed  Google Scholar 

  20. Argenziano M, Oz MC, Kohmoto T et al (2003) Totally endoscopic atrial septal defect repair with robotic assistance. Circulation 108(Suppl 1):II191–I194. https://doi.org/10.1161/01.cir.0000089043.82199.2f

    Article  PubMed  Google Scholar 

  21. Yang M, Wu Y, Wang G et al (2015) Robotic total arterial off-pump coronary artery bypass grafting: seven-year single-center experience and long-term follow-up of graft patency. Ann Thorac Surg 100:1367–1373. https://doi.org/10.1016/j.athoracsur.2015.04.054

    Article  PubMed  Google Scholar 

  22. Gao C, Yang M, Xiao C et al (2012) Robotically assisted mitral valve replacement. J Thorac Cardiovasc Surg 143:S64–S67. https://doi.org/10.1016/j.jtcvs.2012.01.045

    Article  PubMed  Google Scholar 

  23. Gao C, Yang M, Wang G et al (2010) Excision of atrial myxoma using robotic technology. J Thorac Cardiovasc Surg 139:1282–1285. https://doi.org/10.1016/j.jtcvs.2009.09.013

    Article  PubMed  Google Scholar 

  24. Tarola CL, Al-Amodi HA, Balasubramanian S et al (2017) Ultrafast track robotic-assisted minimally invasive coronary artery surgical revascularization. Innov Phila Pa 12:346–350. https://doi.org/10.1097/IMI.0000000000000401

    Article  Google Scholar 

  25. Giambruno V, Chu MW, Cucchietti C et al (2018) Robotic-assisted coronary artery bypass surgery: an 18-year single-centre experience. Int J Med Robot Comput Assist Surg MRCAS. https://doi.org/10.1002/rcs.1891

    Article  Google Scholar 

  26. Carpentier A, Loulmet D, Carpentier A et al (1996) Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. C R Acad Sci III 319:219–223

    PubMed  CAS  Google Scholar 

  27. Deeba S, Aggarwal R, Sains P et al (2006) Cardiac robotics: a review and St. Mary’s experience. Int J Med Robot Comput Assist Surg MRCAS 2:16–20. https://doi.org/10.1002/rcs.76

    Article  CAS  Google Scholar 

  28. Loulmet D, Carpentier A, d’Attellis N et al (1999) Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg 118:4–10. https://doi.org/10.1016/S0022-5223(99)70133-9

    Article  PubMed  CAS  Google Scholar 

  29. Whellan DJ, McCarey MM, Taylor BS et al (2016) Trends in robotic-assisted coronary artery bypass grafts: a study of the society of thoracic surgeons adult cardiac surgery database, 2006 to 2012. Ann Thorac Surg 102:140–146. https://doi.org/10.1016/j.athoracsur.2015.12.059

    Article  PubMed  Google Scholar 

  30. Bonatti JO, Zimrin D, Lehr EJ et al (2012) Hybrid coronary revascularization using robotic totally endoscopic surgery: perioperative outcomes and 5-year results. Ann Thorac Surg 94:1920–1926. https://doi.org/10.1016/j.athoracsur.2012.05.041 (discussion 1926)

    Article  PubMed  Google Scholar 

  31. Wiedemann D, Schachner T, Bonaros N et al (2013) Robotic totally endoscopic coronary artery bypass grafting in men and women: are there sex differences in outcome? Ann Thorac Surg 96:1643–1647. https://doi.org/10.1016/j.athoracsur.2013.05.088

    Article  PubMed  Google Scholar 

  32. Hällberg V, Palomäki A, Lahtela J et al (2014) Associations of metabolic syndrome and diabetes mellitus with 16-year survival after CABG. Cardiovasc Diabetol 13:25. https://doi.org/10.1186/1475-2840-13-25

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Falk V, Walther T, Autschbach R et al (1998) Robot-assisted minimally invasive solo mitral valve operation. J Thorac Cardiovasc Surg 115:470–471. https://doi.org/10.1016/S0022-5223(98)70295-8

    Article  PubMed  CAS  Google Scholar 

  34. Paul S, Isaacs AJ, Jalbert J et al (2015) A population-based analysis of robotic-assisted mitral valve repair. Ann Thorac Surg 99:1546–1553. https://doi.org/10.1016/j.athoracsur.2014.12.043

    Article  PubMed  Google Scholar 

  35. Mihaljevic T, Jarrett CM, Gillinov AM et al (2011) Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. J Thorac Cardiovasc Surg 141:72–80. https://doi.org/10.1016/j.jtcvs.2010.09.008 (e1–4)

    Article  PubMed  Google Scholar 

  36. Magruder JT, Collica S, Belmustakov S et al (2016) Predictors of late-onset atrial fibrillation following isolated mitral valve repairs in patients with preserved ejection fraction. J Card Surg 31:486–492. https://doi.org/10.1111/jocs.12774

    Article  PubMed  Google Scholar 

  37. Nazarov VM, Zheleznev SI, Bogachev-Prokophiev AV et al (2014) CardiaMed mechanical valve: mid-term results of a multicenter clinical trial. Asian Cardiovasc Thorac Ann 22:9–17. https://doi.org/10.1177/0218492312464035

    Article  PubMed  Google Scholar 

  38. Gregers E, Ahlberg G, Christensen T et al (2017) Deep sequencing of atrial fibrillation patients with mitral valve regurgitation shows no evidence of mosaicism but reveals novel rare germline variants. Heart Rhythm 14:1531–1538. https://doi.org/10.1016/j.hrthm.2017.05.027

    Article  PubMed  Google Scholar 

  39. Goldstein D, Moskowitz AJ, Gelijns AC et al (2016) Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 374:344–353. https://doi.org/10.1056/NEJMoa1512913

    Article  PubMed  CAS  Google Scholar 

  40. Moss E, Halkos ME, Miller JS, Murphy DA (2016) Comparison of endoscopic robotic versus sternotomy approach for the resection of left atrial tumors. Innov Phila Pa 11:274–277. https://doi.org/10.1097/IMI.0000000000000282

    Article  Google Scholar 

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Authors and Affiliations

  1. Laboratory for Experimental Surgery and Surgical Research “N.S Christeas”, Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str, 11b, Goudi, 11527, Athens, Greece

    Ilias P. Doulamis, Eleftherios Spartalis, Dimitrios Patsouras, Diamantis I. Tsilimigras, Dimitrios C. Iliopoulos, Aspasia Tzani & Nikolaos I. Nikiteas

  2. Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece

    Ilias P. Doulamis, Eleftherios Spartalis, Nikolaos Machairas, Dimitrios Schizas, Dimitrios Patsouras, Dimitrios Dimitroulis & Nikolaos I. Nikiteas

  3. 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece

    Nikolaos Machairas

  4. 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece

    Dimitrios Schizas

  5. Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

    Michael Spartalis

  6. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Demetrios Moris

  7. 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece

    Dimitrios Dimitroulis

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  1. Ilias P. Doulamis
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  2. Eleftherios Spartalis
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Correspondence to Ilias P. Doulamis.

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IPD, ES, NM, DS, DP, MS, DIT, DM, DCI, AT, DD and NIN declare that they have no conflict of interest.

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Doulamis, I.P., Spartalis, E., Machairas, N. et al. The role of robotics in cardiac surgery: a systematic review. J Robotic Surg 13, 41–52 (2019). https://doi.org/10.1007/s11701-018-0875-5

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  • DOI: https://doi.org/10.1007/s11701-018-0875-5

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