Reply

Abstract

We would like to thank Dr Kumar [1Kumar A.S. Robotic surgery.Ann Thorac Surg. 2007; 84 (letter): 714Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] for his discussion and stimulating comments. We did not mention cost, as high costs for robotics are probably a well-known fact in the heart surgery community [2Bonaros N. Schachner T. Oehlinger A. et al.Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome.Ann Thorac Surg. 2006; 82: 687-694Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar]. Cost-benefit calculations are also difficult; however a single center cost-benefit analysis provides evidence that the benefits of robotic surgery may justify investment in this new technology [3Morgan J.A. Thornton B.A. Peacock J.C. et al.Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques.J Card Surg. 2005; 20: 246-251Crossref PubMed Scopus (87) Google Scholar]. In our opinion, any comparisons with the standard sternotomy procedures are totally unjustified at this point of development, because all robotic cardiac surgery groups are still in their learning curves. Once the procedures are more standardized, quicker cost comparisons should be carried out, especially taking into account the potential benefits in the early rehabilitation phase [4Morgan J.A. Peacock J.C. Kohmoto T. et al.Robotic techniques improve quality of life in patients undergoing atrial septal defect repair.Ann Thorac Surg. 2004; 77: 1328-1333Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar]. A sternotomy patient will probably not resume every day activities during the second postoperative week, as the majority of our totally endoscopic-atrial septal defect repair patients who did become active at that time. We congratulate Dr Kumar [1Kumar A.S. Robotic surgery.Ann Thorac Surg. 2007; 84 (letter): 714Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] on tremendously quick operating room times. Probably a huge number of atrial septal defect II patients are treated at their institution. Operating room time reduction is not the primary aim of our current program. Our goal is to develop complete endoscopic procedures in heart surgery, and the first successful steps have been taken using the daVinci telemanipulation system. We regard our longer operating room times as an investment into development of less destructive approaches to surgical treatment of heart disease. All of us are so used to the sternotomy that we may disregard its destructive and irreversible nature. The patient sees this very differently. Most young women are affected by atrial septal defect II in adulthood, and for them a port only approach is certainly an attractive offer. For all patients, preservation of thoracic and personal integrity is probably the most striking argument. Robotic SurgeryThe Annals of Thoracic SurgeryVol. 84Issue 2PreviewThe article by Bonaros and colleagues [1] interested me for many reasons. These authors deserve our heartiest congratulations for their efforts and for this transparent publication. Primarily it is time for a reappraisal of the robotic surgical technique, especially in the developing nations. Our own observations [2] are in consonance with the comments of Dr Mack [3]. Full-Text PDF