Excision of atrial myxoma using robotic technology

Objective

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).

Methods

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 × 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° angled endoscope facing upward with the da Vinci S robot.

Results

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.

Conclusions

The excision of atrial myxomas with the da Vinci S Surgical System is feasible, efficacious, and safe. Surgical results are excellent.

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, ICS, intercostal space, TEE, transesophageal echocardiography

CTSNet classification: 18, 28