Xu thế mới trong phẫu thuật tim mạch ít xâm lấn nội soi hay có tay máy hỗ trợ

New Trends in Minimally Invasive and Robotic Cardiac Surgery Tatsuya Tarui, Hiroshi Ohtake, and Go Watanabe NewHeart Watanabe Institute NewHeart Watanabe Institute 2016/10/18 NewHeart Watanabe Institute Cardiac surgery in NewHeart Watanabe Institute • April, 2014 - September 2016 • 729 cardiac surgery • CABG : 153 cases, Valve : 498, Aorta : 38 • Success rate 99.7% 30-40% performed by MICS Today's Point Why less invasive? 2016/10/18 Why less invasive? Difficult? Time consuming? Full Sternotomy Advantage • Easy • Fast • Concomitant surgery Disadvantage • Bleeding • Pain • Infection （mediastinitis） Which Is Better? MICS ROBOTIC 2016/10/18 Full Sternotomy Minimally Invasive Cardiac Surgery (MICS) Mitral Valve Plasty 2016/10/18 Full sternotomy vs MICS MICS MVP by Team Watanabe • Video 2016/10/18 2016/10/18 MICS MVP by Team Watanabe 100 MICS MVP cases 99 successful case Hospital mortality Robotic Mitral Valve Plasty 2016/10/18 J Thorac Cardiovasc Surg 2014 Jan;147(1):228-35 2016/10/18 da Vinci Surgical System®  3D vision  freedom of arm  Small incision 18 NewHeart Watanabe Institute Surgery by ports 2016/10/18 NewHeart Watanabe Institute Robotic MVP 2016/10/18 Robotic mitral valve plasty Video 2016/10/18 Robotic MVP by Team WATANABE • May 2014 to August 2016, 60 patients underwent Robotic MVP by team Watanabe Procedure for Robotic MVP • Resection suture:24(40%) • Artificial neochordae by loop technique:24(40%) • Foldoplasty:12(20%) • Edge to edge technique:8 (13%) 2016/10/18 Robotic MVP by Team WATANABE • Operation time 232±68 minutes • Cardiopulmonary bypass time 130±31 minutes • Aortic cross clamp time 71±16 minutes • ICU stay • Hospital stay 1.3±1.0 days 16±6 days 2016/10/18 Robotic MVP by Team WATANABE • Transfusion 14 patients (23%) • Post-operative echocardiograms degrees of mitral regurgitation: none 29 (48%) trivial 28 (46%) mild (3%) moderate (2%), and severe 2016/10/18 Conclusion • MICS and Robotic surgery has a trend to overcome the standard sternotomy • Less invasive surgery may become a world standard 2016/10/18 Conclusion Which Is Better? MICS and Robotics is Better! 2016/10/18 ... MVP by Team WATANABE • Operation time 232±68 minutes • Cardiopulmonary bypass time 130±31 minutes • Aortic cross clamp time 71±16 minutes • ICU stay • Hospital stay 1.3±1.0 days 16±6 days 2016/10/18... 30-40% performed by MICS Today''s Point Why less invasive? 2016/10/18 Why less invasive? Difficult? Time consuming? Full Sternotomy Advantage • Easy • Fast • Concomitant surgery Disadvantage • Bleeding