Harry W. Donias

Minimally invasive mitral valve surgery: From Port Access to fully robotic-assisted surgery

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve opera tions through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.

The Hybrid Approach to Coronary Artery Revascularization: Minimally Invasive Direct Coronary Artery Bypass with Percutaneous Coronary Intervention:

In the past decade, new developments in cardiology and cardiac surgery have begun to offer patients a variety of new, less invasive options for the treatment of coronary artery disease. One such option is the hybrid approach to coronary artery revascularization. This combines minimally invasive direct coronary artery bypass surgery (MIDCAB) of the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) of the remaining diseased coronary arteries. This approach, as an alternative to conventional coronary artery bypass surgery, retains the benefit of internal mammary artery bypass to the LAD, accom plished with a minimally invasive technique, substitutes PCI for saphenous vein grafts as treatment for low-grade lesions of other coronary arteries, and may provide a maximally bene ficial outcome for many patients. Preliminary outcomes of patients receiving the hybrid approach have been strikingly positive. This report highlights the rationale for the development of this procedure, patient selection, results, and future applications of this emerging method of treating coronary artery disease.

Percutaneous revascularization versus beating heart CABG or CABG with cardiopulmonary bypass in patients with refractory myocardial ischemia.

Morrison et al. [(1)][1]recently reported the results of a very important multicenter randomized trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft surgery (CABG) for patients with refractory myocardial ischemia and risk factors for adverse outcomes with

Robotics in Pediatric Surgery Training

Background: The purpose of this study was to determine the prevalence of robotics in North American pediatric surgical training programs, as well as the experience of pediatric surgical residents with this new technology. Methods: A postal survey was sent to all the program directors of accredited pediatric surgery training programs in North America. All the responses were tabulated and analyzed. Results: The largest group of responders, 36%, identified minimal access surgery (MAS) as an area of special interest or expertise. Twenty-three percent of responders have used robotics in their practice. Fifty-nine percent of program directors felt robotics would play at least an important role in the future of pediatric surgery. Currently, residents from 32% of responding North American training programs have exposure to robotic technology. Forty-one percent of responding programs identified plans to incorporate some form of robotic training into their curriculum for pediatric surgery residents. Conclusion: The...

Anesthetic and surgical improvements and pitfalls in endoscopic atraumatic coronary artery bypass grafting.

THE TECHNIQUE OF minimally invasive direct coronary artery bypass (MIDCAB) has been extensively modified since 1995; at present, the procedure has evolved significantly and is referred to as endoscopic atraumatic coronary artery bypass grafting (Endo ACAB). In this procedure, the left internal mammary artery (LIMA) is harvested, and identification of the left anterior descending (LAD) artery is performed endoscopically with robotic assistance. The MIDCAB is then performed through a smaller incision that directly overlies the LAD. The learning experience continues, and there is constant improvement in the tools used. Many of the modifications have been made to overcome technical difficulties associated with port-access harvesting of the LIMA and endoscopic stabilization of the LAD, and although the Endo ACAB is performed without cardiopulmonary bypass (CPB) like the off-pump coronary artery bypass (OPCAB) procedure, there are many differences in the anesthetic management of these patients. The purpose of this article is to help accelerate the learning curve of this procedure.