Ann Thorac Surg 2005;80:2313
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Constantine Mavroudis, MD
Division of Cardiovascular-Thoracic Surgery, The Children's Memorial Hospital, 2300 Children's Plaza, M/C 22, Chicago, IL60614
(Email: cmavroudis{at}childrensmemorial.org).
Suematsu and colleagues [1] have presented their experience with endoscopic robotic assisted repair of patent ductus arteriosus and vascular ring in children. The authors describe their technique in 15 patients (body mass > 14 kg) with patent ductus arteriosus (n = 9) and vascular ring (n = 6). The patent ductus arteriosus was clipped in situ without division and the vascular rings, which had atretic segments, were clipped and divided. Only 1 patient required open technique conversion because of dense adhesions. There were no complications and aside from the longer operative time, the authors were satisfied with the clinical outcome.
As the authors have noted in their article, significant technological advances in thoracoscopic instruments and high-resolution cameras have made robotic surgical systems possible. Interestingly, these systems have been applied mostly to adults with mitral valve disease because of the convenience of intracardiac access and cardiopulmonary bypass techniques that employ femoral cannulation. We do not see these techniques being applied to ascending thoracic aneurysm repair or the Ross operation or other operations with long and complex suture lines that require meticulous hemostasis. It is a technology that has a convenient place for some operations at the present time.
As to the philosophy of performing congenital cardiac operations with this technology, the future will have to decide this question. However at the present time, this clinical series is a technology looking for an application to congenital heart surgery. There are a myriad of operations in congenital heart surgery for which this technology would not apply for a number of reasons, including cessation of bleeding, multiple site repairs and the like. To add to the literature expensive and time-consuming alternative methods to repair patent ductus arteriosus and vascular rings, especially when other less invasive techniques are available must be justified by controlled studies as the authors are doing. No doubt, follow-up studies, scientific advances, and cost effective analyses will determine future application of this interesting technology.
 |
References
|
|---|
- Suematsu Y, Mora BN, Mihaljevic T, del Nido PJ. Totally endoscopic robotic-assisted repair of patent ductus arteriosus and vascular ring in children Ann Thorac Surg 2005;80:2309-2313.[Abstract/Free Full Text]
Top
References