Areas of Exploration

Isolation and Radiofrequency Ablation of the Left Atrial Pulmonary Vein via Minimally Invasive Surgery for Atrial Fibrillation

This study evaluated the feasibility of performing a minimally invasive left atrial isolation on a beating heart using the da Vinci Robotic Surgical System and a flexible microwave probe. The study found the procedure is feasible. However, despite creating an electrical block, tansmurality was not demonstrated consistently and further confirmation of catheter positioning is necessary during a right-chest-only approach.

Safety of the Flex 10 Microwave Catheter with Repeated Ablations

Surgical treatment of atrial fibrillation using a unipolar energy source has resulted in case reports of mediastinal injury, including esophageal perforation. The objective of our study was to test the safety of a unipolar microwave catheter, when used repeatedly, to ablate cardiac tissue and assess for evidence of mediastinal tissue damage. Five of the six subjects achieved ten ablations and one achieved three and a half ablations secondary to catheter dysfunction. All six subjects made an uneventful recovery and underwent autopsy at three months. At autopsy there was no evidence of “collateral” damage to any mediastinal tissue. Even with maximal ablations, no subject suffered an adverse outcome such as esophageal or mediastinal injury.

Robotic, Totally Endoscopic Coronary Artery Bypass Procedure ("TECAB" Procedure)

The purpose of this study was to determine if a coronary bypass procedure can be performed on a beating heart in a without needing to open the chest by using the da Vinci surgical system. The secondary goal of this study was to compare anastomotic techniques. The first was a hand-sewn distal anastomosis using 7-0 prolene and the second technique was an anastomosis via Coalescent surgical clips U-clips. Operation time with U-clips was significantly shorter than conventional running suture (p=0.002). However, there was no significant difference in IMA mobilization time, lipectomy/pericardiotomy, LAD identification, subxiphoid port placement, stabilizer position, LAD dissection time, and anastomosis time between the cases performed with the conventional running suture to the cases performed with u-clips. Interrupted clip anastomosis or conventional running suture anastomoses are equally favorable in the short term when performing a TECAB procedure.

Replacement of the Descending Aorta using the daVinci Surgical System in a Sheep Model: Comparison of Anastomosis Techniques

Robotic assisted surgery has made replacement of the descending aorta a possibility. The purpose of our study was to assess the feasibility of a closed-chest replacement of the descending thoracic aorta utilizing the daVinci surgical robotic system and to compare hand-sewn conventional anastomosis to interrupted nitinol clips (Coalescent Surgical). The average procedure time was 93 minutes. Cross-clamp times range from 55 to 25 minutes (average of 37 minutes). There was no significant difference in time between U-clip anastomoses (17±4.8 minutes) and sutured anastomoses (10.6±3.1 minutes) (p=0.057). The burst pressure was significantly higher for sutured anastomosis than for U-clips (214.6±61 and 110±35 respectively) (p=0.05). Replacement of the descending aorta with a graft is feasible in a closed chest model utilizing the daVinci surgical system. While mean burst strengths were higher with a sutured anastomosis, there was no difference in time or ultimate hemostasis between techniques.