Totally endoscopic computer-enhanced atrial septal defect closure in six patients

Background. Totally endoscopic procedures have been introduced into cardiac surgery with the application of telemanipulating robotic systems. We repor t 6 cases of closed-chest atrial septal defect (ASD) closure using a roboti c device. Methods. After deflating the right lung, the endoscopic camera and two robo tic arms were inserted into the right hemithorax through 8-mm ports. An acc essory port was placed for blood suction and for introduction of ancillary endoscopic instruments. After femoral-femoral cannulation for cardiopulmona ry bypass (CPB), aortic occlusion, and cardioplegia delivery, the intracard iac correction was carried out in 5 patients with an ostium secundum ASD an d in 1 patient with a patent foramen ovale (PFO) and atrial septal aneurysm (ASA). The ASDs were closed with a continuous braided polyester suture. Th e PFO closure with septal aneurysm plication was carried out with interrupt ed stiches. Results. Mean CPB and cross-clamp times were 106 +/- 22 and 67 +/- 13 minut es, respectively. Extubation was carried out within the seventh postoperati ve hour. All patients returned to normal function within the first postoper ative week. Conclusions. Totally endoscopic ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and an excellent cosm etic result. (C) 2001 by The Society of Thoracic Surgeons.