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Ann Thorac Surg 2005;80:2309-2313
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Totally Endoscopic Robotic-Assisted Repair of Patent Ductus Arteriosus and Vascular Ring in Children

Department of Cardiac Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts

Accepted for publication May 20, 2005.

^_* Address correspondence to Dr del Nido, Department of Cardiac Surgery, Children's Hospital-Boston, 300 Longwood Ave, Boston, MA02115 (Email: pedro.delnido{at}tch.harvard.edu).

Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: This study reports on our initial experience with robotically assisted patent ductus arteriosus (PDA) closure and vascular ring division in children.

METHODS: From April 2002 to May 2004, 15 patients underwent PDA closure (n = 9) and vascular ring repair (n = 6) by a totally endoscopic approach, utilizing the Da Vinci robotic system. The mean age of the patients was 8.3 ± 4.7 years (range, 3 to 18) and the mean weight, 35.5 ± 19.0 kg (range, 14.1 to 77.0 kg). Three thoracoscopic trocars were used to accommodate the endoscopic camera and two surgical instruments with an additional small incision for lung retraction. After dissection by the surgeon seated at the master console, PDA ligation with clips or division of the atretic arch and ductal ligament was performed.

RESULTS: Total operative times were 170 ± 46 minutes (PDA) and 167 ± 48 minutes (vascular ring). One patient with vascular ring was converted to thoracotomy because of dense adhesions due to previous surgery. Precise and easy surgical maneuver was possible with the articulated surgical instruments and three-dimensional visualization in 14 patients. Intraoperative transesophageal echocardiography confirmed no persistent shunt in all PDA patients. No laryngeal nerve injury and hemorrhage were noted. All patients were extubated in the operating room. Median length of postoperative hospital stay was 1.5 days.

CONCLUSIONS: Robotically assisted PDA closure and vascular ring division is a feasible and safe procedure. Future technologic improvement, including smaller instrument size and incorporation of tactile feedback, may permit application of this technique to even younger infants and intracardiac repairs.

This article has been cited by other articles:

				P. Modi, E. Rodriguez, and W. R. Chitwood Jr. Robot-assisted cardiac surgery Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 500 - 505. [Abstract] [Full Text] [PDF]

				B. L. Robinson, M. Nathan, D. W. Brown, C. Baird, and P. J. del Nido Robotic Division of an Unusual Variant of a Right Aortic Arch Ann. Thorac. Surg., August 1, 2007; 84(2): 670 - 673. [Abstract] [Full Text] [PDF]

				C. Mavroudis Invited commentary Ann. Thorac. Surg., December 1, 2005; 80(6): 2313 - 2313. [Full Text] [PDF]