robotic cardiac surgery 2018 · • understand the value of robotics in cardiac surgery • know...
Post on 13-Jul-2020
1 Views
Preview:
TRANSCRIPT
Robotic Cardiac Surgery 2018:
What Procedures Can a Dedicated Program Offer?
Husam H Balkhy MD
Professor of Surgery
Director Robotic and Minimally Invasive Cardiac Surgery
University of Chicago Medicine
Winter Workshop 2018
Disclosure
• Proctor Intuitive Surgical
• Proctor: Atricure
• Proctor Liva Nova
• Avid practitioner of robotic cardiac surgery
2Presentation Title Here |
We’re in Athens!!
3Presentation Title Here |
Objectives
• Understand the value of Robotics in Cardiac Surgery
• Know the scope and depth of a fully committed and multifaceted
robotic cardiac surgical program.
• Understand the indications inclusion and exclusion criteria for various
cardiac robotic procedures
• See live examples of a wide range of robotic cardiac surgical
procedures
Why would we want to use Robotics in Cardiac Surgery?
da VinciTM System Coronary Bypass Post-op Patient
Sternotomy Coronary Bypass Post-op Patient
“Patients don’t like sternotomies”Delos Cosgrove, M.D.
STS 1996
Most Cardiac Surgical procedures require much more dexterity and precision than can be afforded by traditional laparoscopic and thoracoscopic approaches
Why would we want to use Robotics in Cardiac Surgery?
Endoscopic Surgery is Limited
-Unnatural operative feel -2-D vision
-Hands and instruments misaligned-Incisions very small, a few millimeters-Very limited dexterity inside patient -Long instruments -Hands/wrists outside patient -Fixed instrument tips inside patient
Why Robotics?• Completely Endoscopic Surgery
• Least Invasive surgical approach
• 3D visualization and articulating instruments lead to enhanced precision
• Both Epicardial and Endocardial access to the heart
9Presentation Title Here |
Why Robotics?
PrecisionAccuracy and Safety
Enhanced Dexterity
Robotic Procedures in 2018
• Intra cardiac procedures (Valves, AS, Myxoma etc..)
• Coronary Bypass (Totally Endoscopic)
• Atrial Fibrillation and other Ablation procedures
• Other:
– Pacer lead Placement/ Removal
– Pericardial Resection
What Intra cardiac procedures can be performed Totally
Endoscopically with the Robot in 2018?
– Mitral valve repair
– Tricuspid valve repair
– Combined MV and TV repair
– ASD repair
– Atrial Myxoma
– Resection Ventricular septum (HOCM)
– Resection Fibroelastoma (Mitral/Aortic valve
– Cryo Maze
12Presentation Title Here |
13Presentation Title Here |
Robotic Intra-cardiac Procedures
14
Redo Robotic MV repair, TV, CryoMaze
Robotic Endoscopic ASD Repair
Robotic Endoscopic ASD Repair: Unroofed CS
What procedures do we perform with the robot in 2018?
• Totally Endoscopic CABG (TECAB)
– Single vessel TECAB: (usually LIMA-LAD)
– Multi-vessel TECAB
• Bilateral IMA (LIMA and RIMA)
• Sequential LIMA
– Hybrid Revascularization
• PCI First
• TECAB First
18Presentation Title Here |
C-Port Distal anastomotic Device
21Presentation Title Here |
TECAB: Operative Setup
22
TECAB: Operative Setup
Multivessel Connector TECAB
24
Robotic TECAB: Sequential LIMA D1-LAD
-LIMA > Diag - LAD-End to side first: Flex A-Side to side: S18 U clips
Robotic TECAB: Sequential LIMA D1-LAD
26
LIMA-LAD Patency: (mid term): 98.2%
28Presentation Title Here |
Robotic Endoscopic Release of Myocardial Bridge
29Presentation Title Here |
Combined Robotic MV TECAB?
30Presentation Title Here |
60 year old male with severe MR and tight prox LAD lesionUnderwent totally endoscopic complex MV repair and LIMA LAD via ports.Home in 3 daysBack to work in 10 days
• “Best of both worlds”: (B)IMA + benefits of minimally invasive
• Expands minimally invasive CABG
• Expands PCI (e.g. protected LM)
• Angiographic confirmation of grafts
Hybrid Coronary Revascularization
What Other procedures can be performed with the
robot in 2018?
Atrial Fibrillation surgery:
– Pulmonary vein isolation with Conduction Block testing
– LAA ligation
– Arrested heart Cryo Maze procedure
Other Epicardial Procedures:
– LV lead placement for Bi Ventricular pacing (intelligent CRT)
– Pericardial drainage and stripping (constrictive pericarditis)
– TMR?
34Presentation Title Here |
AF Ablation: Epicardial RF
35Presentation Title Here |
Hybrid AF ablation
36Presentation Title Here |
VT Ablation: LV Summit exposure
• Epicardial VT Ablation
37Presentation Title Here |
Mapping Guided CRT: Smart Resynchronization
38Presentation Title Here |
Lead Complications
39Presentation Title Here |
40
Totally Endoscopic BH Pericardiectomy
41Presentation Title Here |
How About the Aortic Valve?
42Presentation Title Here |
43
Robotic Assisted Aortic Valve surgery
• Leverages success
with Robotic MV
surgery
• Excellent view of
Aortic valve
• Ports one or two
interspaces higher
• Chitwood clamp
44Presentation Title Here |
Robotic AVR 3f
45Presentation Title Here |
Sutureless AVR
46Presentation Title Here |
Robotic Perceval AVR
47Presentation Title Here |
Adult Congenital Cardiac Surgery: Anomalous Left PV Drainage
48Presentation Title Here |
Post-operative length of stay
• Robotic TECAB: 2-3 days
• Robotic MV repair/ Port Access AVR: 3 days
• Robotic AF Ablation: 2 days
49Presentation Title Here |
Robotic Totally Endoscopic Beating Heart Coronary Bypass
(TECAB)Inclusion Criteria
• CAD involving the LAD, Diagonal, and
high Marginal branches of the
Circumflex coronary artery
• CAD involving the the proximal RCA
• Patients needing one or two IMA grafts
(single, double or triple bypass)
• Patients with 3 vessel coronary disease
as part of a ‘Hybrid Revascularization’
strategy
Exclusion Criteria
• Previous left lung surgery
• Severe COPD/ emphysema
• Severe scarring secondary to previous
sternotomy/ bypass surgery
• Cardiogenic Shock
• Very poor ventricular function
• Need for Emergency CABG surgery
Robotic Mitral and Tricuspid Valve Surgery
Inclusion Criteria
• Myxomatous Mitral valve degeneration
causing severe mitral regurgitation
requiring simple or complex repair
• Patients with severe Mitral regurgitation
requiring Mitral valve replacement
• Patients with severe tricuspid valve
regurgitation
• Patients with Mitral valve disease and
single vessel CAD amenable to PCI
Exclusion Criteria
• Severe scarring from previous right
lung surgery
• Severe COPD/ emphysema
• Associated 3 vessel CAD
• Severe scarring secondary to previous
sternotomy/ bypass surgery
• Very poor ventricular function
• Need for Emergency surgery
Conclusion:
• Adapting robotics can enhance minimally invasive cardiac surgery by
increasing dexterity and visualization to produce a truly MIS approach.
• Multiple intra and epi- cardiac procedures can be performed safely
and effectively enhancing outcomes and shortening recovery time.
• Increasing the number and variety of procedures performed allows the
team to become comfortable and facile with the system.
52Presentation Title Here |
The TEAM!
53Presentation Title Here |
Thank you
top related