Robotic and Minimally Invasive Cardiac Surgery

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Presentation transcript:

Robotic and Minimally Invasive Cardiac Surgery William Vernick, MD, Pavan Atluri, MD Anesthesiology Clinics Volume 31, Issue 2, Pages 299-320 (June 2013) DOI: 10.1016/j.anclin.2012.12.002 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 Robotic-assisted incision along lateral inframammary crease as well as robotic port sites. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 Intraoperative videoscopic view of mitral valve during minimally invasive mitral valve surgery. Annuloplasty sutures have been placed to facilitate exposure of valve and inspection of leaflet pathology. Markedly redundant prolapsed posterior leaflet P2 segment is demonstrated. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 Two surgeons seen sitting at a dual robotic console during robotic surgery. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 Robotic-assisted mitral valve surgical field with robotic arms in place. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 Enhanced, near 3-dimensional visualization of the valve from the console is provided by 2 side-by-side camera arms, which can be controlled by the surgeon. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 Strategies for providing venous drainage during minimally invasive mitral valve surgery. (A) Single long femoral venous cannula advanced into the right atrium (RA). (B) Long femoral venous cannula advanced into RA in conjunction with endopulmonary vent catheter placed via right IJ introducer sheath. (C) Long femoral venous cannula advanced into RA in conjunction with venous drainage cannula advanced into superior vena cava from right IJ. (Adapted from Rehfeldt KH, Mauermann WJ, Burkhart H, et al. Robotic-assisted mitral valve repair. J Cardiothorac Vasc Anesth 2011;25(4):725; with permission.) Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 7 A 16F venous drainage cannula placed in the right internal jugular (IJ) vein and connected to the bypass circuit. Note a boxed suture placed around the cannula site. A separate 9F introducer catheter with pulmonary artery catheter is seen more cephalad in the ipsilateral neck. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 8 EndoClamp aortic catheter advanced through the Y-shaped EndoReturn arterial cannula, which was placed into the right femoral artery. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 9 Mid-esophageal aortic valve long-axis view with EndoClamp aortic catheter seen inflated in the ascending aorta just distal to the aortic root. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 10 (A) Well-positioned EndoClamp in the ascending aorta. (B) Distal migration (Shown by the arrow) of the EndoClamp and potentially obstructing flow to the innominate artery. (C) Proximal migration (shown by the arrow) of the EndoClamp, which may prevent adequate aortic occlusion or cardioplegia. (Adapted from Kottenberg-Assenmacher E, Kamler M, Peters J. Minimally invasive endoscopic port-access intracardiac surgery with one lung ventilation: impact on gas exchange and anesthesia resources. Anesthesia 2007;62:235; with permission.) Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 11 Surgical field with access incision via small right anterior thoracotomy. The Chitwood clamp is placed percutaneously via an additional incision lateral to the access incision and is directed toward the ascending aorta under direct vision. The right femoral artery and vein are cannulated. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 12 Chitwood clamp seen via direct vision in surgical field during external occlusion of the ascending aorta. The aortic root vent is placed directly through the access incision and is proximal to the clamp in the aorta. The coronary sinus (CS) cannula is also seen passing through the access incision. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 13 Modified mid-esophageal right-sided 2-chamber view with focus on ostia of the coronary sinus. CS, coronary sinus; RA, right atrium; RV, right ventricle. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 14 EndoPledge coronary sinus catheter advanced into the coronary sinus. Anesthesiology Clinics 2013 31, 299-320DOI: (10.1016/j.anclin.2012.12.002) Copyright © 2013 Elsevier Inc. Terms and Conditions