Autschbach R, Onnasch J F, Falk V, Walther T, Krüger M, Schilling L O, Mohr F W
Department of Cardiac Surgery, University of Leipzig, Germany.
J Card Surg. 2000 Jan-Feb;15(1):82-7. doi: 10.1111/j.1540-8191.2000.tb00447.x.
The study describes the single-center experience using robot-assisted videoscopic mitral valve surgery and the early results with a remote telemanipulator-assisted approach for mitral valve repair.
Out of a series of 230 patients who underwent minimally invasive mitral valve surgery, in 167 patients surgery was performed with the use of robotic assistance. A voice-controlled robotic arm was used for videoscopic guidance in 152 cases. Most recently, a computer-enhanced telemanipulator was used in 15 patients to perform the operation remotely.
The mitral valve was repaired in 117 and replaced in all other patients. The voice-controlled robotic arm (AESOP 3000) facilitated videoscopic-assisted mitral valve surgery. The procedure was completed without the need for an additional assistant as "solo surgery." Additional procedures like radiofrequency ablation and tricuspid valve repair were performed in 21 and 4 patients, respectively. Duration of bypass and clamp time was comparable to conventional procedures (107 A 34 and 50 A 16 min, respectively). Hospital mortality was 1.2%. Using the da Vinci telemanipulation system, remote mitral valve repair was successfully performed in 13 of 15 patients.
Robotic-assisted less invasive mitral valve surgery has evolved to a reliable technique with reproducible results for primary operations and for reoperations. Robotic assistance has enabled a solo surgery approach. The combination with radiofrequency ablation (Mini Maze) in patients with chronic atrial fibrillation has proven to be beneficial. The use of telemanipulation systems for remote mitral valve surgery is promising, but a number of problems have to be solved before the introduction of a closed chest mitral valve procedure.
本研究描述了单中心使用机器人辅助胸腔镜二尖瓣手术的经验以及采用远程遥控操作器辅助方法进行二尖瓣修复的早期结果。
在230例行微创二尖瓣手术的患者中，167例患者接受了机器人辅助手术。152例患者使用了声控机器人手臂进行胸腔镜引导。最近，15例患者使用了计算机增强型遥控操作器进行远程手术。
117例患者二尖瓣得到修复，其他患者均进行了二尖瓣置换。声控机器人手臂（AESOP 3000）有助于胸腔镜辅助二尖瓣手术。该手术无需额外助手即可作为“单人手术”完成。分别有21例和4例患者进行了诸如射频消融和三尖瓣修复等附加手术。体外循环时间和主动脉阻断时间与传统手术相当（分别为107±34分钟和50±16分钟）。医院死亡率为1.2%。使用达芬奇遥控操作系统，15例患者中有13例成功进行了远程二尖瓣修复。
机器人辅助微创二尖瓣手术已发展成为一种可靠的技术，对于初次手术和再次手术均能产生可重复的结果。机器人辅助实现了单人手术方式。对于慢性心房颤动患者，与射频消融（迷你迷宫手术）联合使用已证明是有益的。使用遥控操作系统进行远程二尖瓣手术前景广阔，但在引入全胸腔二尖瓣手术之前，还需解决一些问题。
