Robotic Cardiac Surgery: Advanced Minimally Invasive Technology Hindered By Barriers to Adoption

Athanasiou, Thanos; Ashrafian, Hutan; Rowland, Simon P.; Casula, Roberto

doi:10.2217/fca.11.40

Cited by 9 publications

(6 citation statements)

References 72 publications

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“…Since the first description by Ebbinghaus 21 in 1885 concerning the study of memory, learning curves have been broadly applied to many fields, from cost projection in manufacturing to the effects of labor productivity in the aircraft industry. 22,23 With continuous advancements in operative technology including the rapid growth of telemanipulative technology, 24 learning curve analyses have been applied across multiple surgical subspecialties. 25Y30 Evaluation of pediatric urology fellows performing robotic pyeloplasties demonstrated a 3.7-minute decrease in console time with each consecutive case, with fellows projected to achieve median attending operative time within 37 cases.…”

Section: Discussionmentioning

confidence: 99%

Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?

Yaffee

Loulmet

Kelly

et al. 2014

Innovations�(Phila)

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Objective A concern with the initiation of totally endoscopic robotic mitral valve repair (TERMR) programs has been the risk for the learning curve. To minimize this risk, we initiated a TERMR program with a defined team and structured learning approach before clinical implementation. Methods A dedicated team (two surgeons, one cardiac anesthesiologist, one perfusionist, and two nurses) was trained with clinical scenarios, simulations, wet laboratories, and “expert” observation for 3 months. This team then performed a series of TERMRs of varying complexity. Results Thirty-two isolated TERMRs were performed during the first programmatic year. All operations included mitral valve repair, left atrial appendage exclusion, and annuloplasty device implantation. Additional procedures included leaflet resection, neochordae insertion, atrial ablation, and papillary muscle shortening. Longer clamp times were associated with number of neochordae ( P < 0.01), papillary muscle procedures ( P < 0.01), and leaflet resection ( P = 0.06). Sequential case number had no impact on cross-clamp time ( P = 0.3). Analysis of nonclamp time demonstrated a 71.3% learning percentage ( P < 0.01; ie, 28.7% reduction in nonclamp time with each doubling of case number). There were no hospital deaths or incidences of stroke, myocardial infarction, unplanned reoperation, respiratory failure, or renal failure. Median length of stay was 4 days. All patients were discharged home. Conclusions Totally endoscopic robotic mitral valve repair can be safely performed after a pretraining regimen with emphasis on experts’ current practice and team training. After a pretraining regimen, cross-clamp times were not subject to learning curve phenomena but were dependent on procedural complexity. Nonclamp times were associated with a short learning curve.

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Section: Discussionmentioning

confidence: 99%

Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?

Yaffee

Loulmet

Kelly

et al. 2014

Innovations�(Phila)

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“…34 These barriers are summarised in Despite the lack of evidence regarding clinical superiority and the fact that robotic cardiac surgery has been consistently shown to be costlier and more time consuming compared with conventional approaches, cardiac surgery represents one of the largest markets in the field of robotic surgery. 33,35,36 It thus becomes apparent that the diffusion of robotic cardiac surgery has outpaced the evidence supporting it. 37 In the United States alone, more than 1,700 cardiac procedures are performed annually, with no decline seen over the past decade.…”

Section: Diffusion Of Innovation and The Evidence Basementioning

confidence: 99%

Robotics in cardiac surgery

Sepehripour

Garas

Athanasiou

et al. 2018

annals

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“…[ 55 ] Significant data has emerged that confirms its safety and efficacy in a range of surgical procedures. [ 56 ]…”

Section: Future Directionmentioning

confidence: 99%

Anesthetic issues for robotic cardiac surgery

Bernstein

Walker

2015

Ann Card Anaesth

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As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.

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Robotic Cardiac Surgery: Advanced Minimally Invasive Technology Hindered By Barriers to Adoption

Cited by 9 publications

References 72 publications

Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?

Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?

Robotics in cardiac surgery

Anesthetic issues for robotic cardiac surgery

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