This Article Full Text Full Text (PDF) On-line Video Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Piergiorgio Tozzi Antonio Corno Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by von Segesser, L. K. Articles by Corno, A. Search for Related Content PubMed PubMed Citation Articles by von Segesser, L. K. Articles by Corno, A. Related Collections Congenital - acyanotic Congenital - cyanotic Minimally invasive surgery Valve disease

Working heart off-pump cardiac repair (OPCARE) – the next step in robotic surgery?

Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, Rue du Bugnon 46 CH-10011 Lausanne, Switzerland

^* Corresponding author. Tel.: +41-21-314-22-80; fax: +41-21-314-22-78
ludwig.von-segesser{at}chuv.hospvd.ch

The objective of the present study was to assess the feasibility of working heart off-pump cardiac repair (OPCARE), for example, for simple congenital defects or valves, with the help of a commercially available surgical robot in order to identify problem areas and to explore potential solutions. OPCARE was studied in four bovine experiments using the Zeus (Computermotion, Santa Barbara, CA, USA) surgical robot providing 3D viewing of the extra cardiac instruments in combination with two intra-cardiac ultrasound visualisation systems (Clearview Ultra, Boston Scientific, La Garenne, France) and Accunav (Accuson, Mountain View, CA, USA) allowing for two different viewing planes of the heart and identification of both, intra-cardiac structures and intra-cardiac robotic instruments. For the given experimental set-up, introduction of robotic instruments into the right atrium (typical for instrumentation during OPCARE), grabbing of the second instrument (typical for removal of intra-cardiac foreign bodies), and grabbing of relatively still atrial structures, which can be visualised by intra-cardiac ultrasound (typical for resection of specific cardiac tissue, clipping of a specific cardiac structure, steered access to other cardiac cavities) have been realised with relative ease. In contrast, grabbing of moving cardiac structures like a–v valve leaflets (typical for valve testing and absolutely necessary for valve repair) required, in general, numerous attempts, but was finally successful in the majority of test animals. Finally, introduction of self-attaching suture material (U-clips, Coalescent Surgical, Sunnyvale, CA, USA) typical for edge-to-edge valve repair could not be performed in reproducible fashion with the equipment used. We conclude that OPCARE is feasible for simple intra-cardiac lesions using current robotic instrumentation and state of the art intra-cardiac ultrasound. However, more complex procedures require further development of both robotic instrumentation and intra-cardiac visualisation.

Key Words: Beating heart surgery; Working heart surgery; Off-Pump surgery; Robotics; Telemanipulation; Intravascular ultrasound; Intra-cardiac ultrasound; Valve repair

This article has been cited by other articles:

				G. M. Guiraudon, D. L. Jones, D. Bainbridge, and T. M. Peters Mitral valve implantation using off-pump closed beating intracardiac surgery: a feasibility study Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 603 - 607. [Abstract] [Full Text] [PDF]

				L. Ma, P. Tozzi, C. H. Huber, S. Taub, G. Gerelle, and L. K. von Segesser Double-crowned valved stents for off-pump mitral valve replacement Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 194 - 198. [Abstract] [Full Text] [PDF]