Clinical Comparison Between Robotic-assisted And Total Thoarcoscopic Surgery In Atrial Septal Defect Closure On Beating Heart

Objective To summarize the clinical experience of atrial septal defect closure in different minimally invasive ways between the ‘da Vinci Si’ surgical robotic-assisted and total thoracoscopic surgery on beating heart.Method Between January 2017 and November 2017,25 cases of atrial septal defect(ASD)were closed using robotic surgical system on beating heart,including tricuspid valve annuloplasty in 7 patients,concomitant repair pulmonary stenosis and partial anomalous venous connection in 1,respectively,in cardiovascular department of Jiang Su Province Hospital.Extracorporeal circulation was established through right femoral artery,femoral vein and right internal jugular vein cannulation with the guidance of transesophageal echocardiography.4 small ports range from 8mm to 25 mm were made in the right chest.After ‘da Vinci Si’ docking was done,the surgeon complete the repair of atrial septal defect using bovine pericardial patch and other concomitant malformation in the surgeon console with three dimensions visualization.Another 35 cases of ASD underwent total thoracoscopic surgery(TTS)from January 2015 to December 2016 were compared with robotic surgery(RS).Analyze the the difference between operation time,cardiopulmonary bypass(CPB)time,amount of drainage,hospital stay,postoperative complications and so on.Result The time of operation and CPB in RS group were prolonged than those in TTS group(P<0.05).No statistical differences were found in ventilation time,intensive care unit stay,hospital stay after surgery,the amount of thoracic drainage between the two groups(P>0.05),but the datum presented a tendency of decrease.All of the patients` enlarged right atrium,right ventricular and left atrium were siginificant smaller after surgery(P<0.05),and no differences about heart improvement were found between the two groups(P>0.05).All cases were completed successfully without major complications.During 1-6 months follow up,the heart function was confirmed as NYHA functional class I and there was no residual shunt.The patients in RS group spent much more than another group(P<0.05).The expenditure patterns were quite different(P=0.01)between the two groups,and the differences were more significant when the cost of robotic surgical system was considered as an independent item(p<0.0001).Conclusion Atrial septal defect closure with robotic-assisted and total thoracoscopic is safe and reliable and have advantages of less injury,rapid discovery,and excellent minimally invasive surgical effect.More complex heart malformations can be repaired with the assistance of robotic surgical system.