Minimally Invasive and Robotic Cardiac Surgery Center, Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.
J Thorac Cardiovasc Surg. 2010 May;139(5):1282-5. doi: 10.1016/j.jtcvs.2009.09.013. Epub 2009 Oct 23.
This study is to discuss a surgical approach for ideal and safe resection of atrial myxoma using the da Vinci S Surgical System (Intuitive Surgical, Inc, Sunnyvale, Calif).
Nineteen consecutive patients underwent resection of atrial myxomas with the da Vinci S Surgical System. Mean age of the patients was 46 +/- 16 years. Mean tumor size was 45 x 5.5 cm. Fifteen tumors were in the left atrium, of which 11 tumors arose from the interatrial septum, 2 from the posterocaudal wall, 1 from the root of the anterior leaflet of the mitral valve, and 1 from the left atrial roof. In 13 patients, exploration was conducted through a left atriotomy anterior to the pulmonary veins and excision was achieved by dissecting a plane through the atrial muscle at the point of attachment. In the first 2 patients, exploration and excision were conducted through an oblique right atriotomy. Four tumors were in right atrium, all of which were resected from the beating heart. The da Vinci instrument arms were inserted through three 1-cm trocar incisions in the right side of the chest. Via 4 port incisions and a 1.5-cm working port, all the procedures were completed with a 30 degrees angled endoscope facing upward with the da Vinci S robot.
Resection was successful in all patients. There were no operative deaths, strokes, or other complications. All the patients were discharged. No recurrences of tumor or septal leakage were found in the complete 1- to 18-month follow-up.
The excision of atrial myxomas with the da Vinci S Surgical System is feasible, efficacious, and safe. Surgical results are excellent.
本研究旨在探讨使用达芬奇 S 手术系统（直觉外科公司，加利福尼亚州森尼韦尔）对心房黏液瘤进行理想且安全切除的手术方法。
19 例连续患者接受了达芬奇 S 手术系统治疗心房黏液瘤切除术。患者平均年龄为 46 ± 16 岁。平均肿瘤大小为 45 x 5.5 厘米。15 个肿瘤位于左心房，其中 11 个肿瘤起源于房间隔，2 个起源于后下壁，1 个起源于二尖瓣前叶根部，1 个起源于左心房顶。在 13 例患者中，通过在肺静脉前的左心房切开术进行探查，并通过在附着点处穿过心房肌肉解剖一个平面来实现切除。在最初的 2 例患者中，通过斜向右心房切开术进行探查和切除。4 个肿瘤位于右心房，均从跳动的心脏中切除。达芬奇器械臂通过胸部右侧的三个 1 厘米 trocar 切口插入。通过 4 个端口切口和 1.5 厘米工作端口，所有程序均使用向上倾斜 30 度的内窥镜和达芬奇 S 机器人完成。
所有患者均成功切除。无手术死亡、中风或其他并发症。所有患者均出院。在完整的 1 至 18 个月随访中，未发现肿瘤或隔瓣漏复发。
使用达芬奇 S 手术系统切除心房黏液瘤是可行、有效且安全的。手术效果极佳。
