Pettinari Matteo, Navarra Emiliano, Noirhomme Philippe, Gutermann Herbert
Division of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
Division of Cardiothoracic and Vascular Surgery, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
Ann Cardiothorac Surg. 2017 Jan;6(1):1-8. doi: 10.21037/acs.2017.01.02.
In the past two decades, the introduction of robotic technology has facilitated minimally invasive cardiac surgery, allowing surgeons to operate endoscopically rather than through a median sternotomy. This approach has facilitated procedures for several structural heart conditions, including mitral valve repair, atrial septal defect closure and multivessel minimally invasive coronary artery bypass grafting. In this rapidly evolving field, we review the status of robotic cardiac surgery in Europe with a focus on mitral valve surgery and coronary revascularization.
Structured searches of MEDLINE, Embase, and Cochrane databases were performed from their dates of inception to June 2016. All original studies, except case-reports, were included in this qualitative review. Studies performed in Europe were presented quantitatively. Data provided from Intuitive Surgical Inc. are also presented.
Fourteen papers on coronary surgery were included in the analysis and reported a mortality rate ranging between 0-1%, revision for bleeding between 2-7%, conversion to a larger incision between 2-15%, and patency rate between 92-98%. The number of procedures ranged between 23 and 170 per year. There were only a small number of published reports for robotic mitral valve surgery from European centers.
Coronary robotic surgery in Europe has been performed safely and effectively with very few perioperative complications in the last 15 years. On the other hand, mitral surgery has been developed later with increasing applications of this technology only in the last 5-6 years.
在过去二十年中，机器人技术的引入推动了微创心脏手术的发展，使外科医生能够通过内镜进行手术，而非采用正中胸骨切开术。这种方法已促进了多种结构性心脏病的手术，包括二尖瓣修复、房间隔缺损闭合以及多支血管微创冠状动脉搭桥术。在这个快速发展的领域，我们回顾欧洲机器人心脏手术的现状，重点关注二尖瓣手术和冠状动脉血运重建。
对MEDLINE、Embase和Cochrane数据库从其创建日期至2016年6月进行结构化检索。除病例报告外的所有原创性研究均纳入本定性综述。对在欧洲进行的研究进行定量呈现。还呈现了直观外科公司提供的数据。
分析纳入了14篇关于冠状动脉手术的论文，报告的死亡率在0 - 1%之间，因出血进行的二次手术率在2 - 7%之间，转为更大切口的转换率在2 - 15%之间，通畅率在92 - 98%之间。每年的手术例数在23至170例之间。欧洲中心关于机器人二尖瓣手术的已发表报告数量很少。
在过去15年中，欧洲的冠状动脉机器人手术已安全有效地实施，围手术期并发症极少。另一方面，二尖瓣手术发展较晚，仅在过去5 - 6年中该技术的应用才有所增加。
