Ann Thorac Surg 2001;72:1357
© 2001 The Society of Thoracic Surgeons
Invited commentary
Tom R. Karl, MDa
a Department of Pediatric Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Suite 8527, Philadelphia, PA 19104-4399, USA
e-mail: karl{at}email.chop.edu
The work of Torraca and associates represents an important technical advance, and it builds on earlier experience as cited by the authors. It would be easy to criticize the clinical work reported herein. The approach is probably as invasive as an open technique: 4 arterial cannulations, 2 venous cannulations, double lumen endotracheal intubation, transeophageal echo probe, and 4 surgical ports (also known as incisions). The cardiopulmonary bypass (CPB) and ischemic times are extraordinary for secundum atrial septal defect (ASD). No benefit in length of hospitalization or patient recovery time are demonstrated. The costs (not mentioned) may be higher than those incurred in the open approach. As such, robotic closure is not (presently) competitive with either catheter or minimally invasive open techniques for secundum ASD. However, to dismiss this important work for the above reasons would be short sighted, and would miss the point completely. Clearly, robotic surgery is in its infancy, and the potential is enormous. The target lesion will not be secundum ASD, although the latter will serve as the proving ground for what is to come. In cardiac surgery, necessity is not always the mother of invention, and whether or not one chooses to embrace it in the current iteration, computer assisted robotic surgical technology is here to stay. The San Raffaele group have given us an impressive report.
Related Article
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Totally endoscopic computer-enhanced atrial septal defect closure in six patients
- Lucia Torracca, Gennaro Ismeno, and Ottavio Alfieri
Ann. Thorac. Surg. 2001 72: 1354-1357.
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