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首页> 外文期刊>Journal of cardiac surgery. >Minimally invasive videoscopic mitral valve surgery: the current role of surgical robotics.
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Minimally invasive videoscopic mitral valve surgery: the current role of surgical robotics.

机译：微创型录像带二尖瓣手术：手术机器人的目前作用。

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OBJECTIVE: Recently, the efficacy of video-assisted mitral valve surgery has been demonstrated. The evolution of this technology has been relatively rapid. In this article we review this development and predict the future of endoscopic and robotic-enabling technology for cardiac valve operations. METHODS: A new video-assisted mitral valve operation is described and results discussed. The majority of each valve operation was done through assisted vision and near endoscopically. Cardiopulmonary bypass was established via femoral cannulation, and blood cardioplegic arrest induced using a new percutaneous, transthoracic cross-clamp. A 5 to 6-cm minithoracotomy was used in each patient. Videoscopy was helpful for suture placement, chord reconstruction, leaflet resection, knot tying, and valve ring or prosthesis positioning. A voice-activated robotic arm was used to direct the camera in many instances. RESULTS: Thus far a total of 110 patients have undergone this operation successfully with a 0.9% operative mortality. Our early series (N = 31), published with cost data, is reviewed in detail. Cardiopulmonary perfusion and cross-clamp times for all 100 patients were longer than for conventional sternotomy patients at 158 +/- 3.9 and 110 +/- 3.6 minutes, respectively, versus 121 +/- 4.6 and 90 +/- 4.6 (N = 105); however, there have been less complications. Operative, perfusion, and arrest times have fallen progressively to 144 +/- 4.5 and 90 +/- 4.5, respectively (N = 55 Aesop 3000 cases). Complex repairs and replacements have become routine with anterior leaflet pathology addressed. Bleeding, ventilatory times, blood transfusions, and hospital stay have been reduced. One patient required reoperation for a technically failed repair and two renal patients had late endocarditis. We have used voice-activated, robotic (Aesop 3000) assistance for camera control in 51 of these patients. This addition has decreased camera motion artifact and lens cleaning, while providing direct "cerebral-eye" tracking of instruments for the surgeon. We were the first in the United States to apply the DaVinci articulated wrist robot to do a complete mitral repair and have done multiple repair with this articulated wrist device. CONCLUSIONS: From this and other work reviewed, we conclude that video-assisted and computer-assisted robotic techniques are safe and may be the pathway to truly endoscopic mitral valve operations. We are encouraged regarding the use of this new technology for mitral valve operations.
机译：目的：近年来，视频辅助二尖瓣手术的疗效已被证明。该技术的发展一直较快。在本文中，我们回顾这一发展，并预测内镜和机器人使能技术的未来心脏瓣膜操作。方法：描述了一种新的视频辅助二尖瓣操作及结果进行讨论。大部分每个阀门的操作是通过辅助视力和近视镜下完成。体外循环经股动脉插管建立，心脏停搏使用新的经皮经胸十字钳阻滞作用。有5至6厘米小切口在每个病人使用。 Videoscopy是为缝合位置，和弦重建，小叶切除，打结，并且瓣环或假体定位的帮助。声控机器人手臂被用来引导相机在许多情况下。结果：迄今为止，共有110例患者进行了成功的这种操作有0.9％的手术死亡率。我们早期的系列（N = 31）中，用成本数据发布，进行详细审查。对于所有100名病人心肺灌注和交叉夹紧时间比常规胸骨切开术的患者不再分别在158±3.9和110±3.6分钟，，相对于121 +/- 4.6和90±4.6（N = 105 ）;然而，也出现了并发症少。手术，灌注，以及逮捕时代已经逐步下降到144分别±4.5和90±4.5，（N = 55伊索3000案件）。复杂的维修和更换已成为惯例与前叶病变解决。止血，通气时间，输血，住院时间已经减少。一位病人需要手术治疗的技术故障修复和两名肾病患者发生晚期心内膜炎。我们已经使用声控，机器人（伊索3000）在这些患者中51摄像机控制的援助。这种加入已经减小相机运动伪影和镜头清洁，同时提供直接的“脑 - 眼”仪器为外科医生的跟踪。我们在美国首次采用达芬奇腕关节机器人做一个完整的二尖瓣修复，也做了多种修复这个关节的腕部设备。结论：从本和审核等工作，我们得出结论，视频辅助和计算机辅助机器人技术是安全的，可能是途径，真正镜下二尖瓣操作。我们感到鼓舞的关于使用这种新技术的二尖瓣操作。

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