Developments in robotic cardiac surgery

A new generation of surgical telemanipulation systems has helped to overcom e the limitations of conventional endoscopic tools. These computer-enhanced instrumentation systems provide tremor filtering and motion scaling and al low dexterous manipulations in confined spaces through ports or trocars. Us ing these systems, total endoscopic coronary artery bypass grafting both on the arrested and on the beating heart has been performed successfully. Rep air of mitral valves as well as atrial septal defects has also been perform ed remotely through 1 centimeter incisions. Despite some early procedural s uccess, operating times are prolonged and a number of conversions have been reported. Currently, the use of telemanipulation systems is restricted to selected patients and limited to very few indications Further refinements i n telemanipulator technology as well as integration of image-based navigati on systems may expand the use of computer-enhanced instrumentation systems in the near future. (C) 2000 Lippincott Williams & Wilkins, Inc.