Robotic Surgery

Abstract

The article by Bonaros and colleagues [1Bonaros 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] 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 [2Sampath Kumar A. In the fast lane.Ind J Thorac Cardiovasc Surg. 2003; 19: 135Crossref Scopus (2) Google Scholar] are in consonance with the comments of Dr Mack [3Mack M. Invited commentary.Ann Thorac Surg. 2006; 82: 693-694Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar].Basically any surgical technique for universal adaptability should be better or advantageous in comparison with existing techniques. Being just as good is perhaps not good enough for change. However in this report, by Bonaros and colleagues [1Bonaros 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], the results suggest that the technique is indeed hazardous. Having completed the study, the authors would have done well to compare their robotic technique with their own conventional atrial septal defect closure technique. At our institution the average times for simple atrial septal defect closure are as follows:Tabled 1Operating time70 minutes (45–96 minutes)Cardiopulmonary bypass30 minutes (11–56 minutes)Aorta cross-clamp time19 minutes (8–43 minutes)Hospital stay4 days (3–8 days)Mortality0 Open table in a new tab Most of these procedures are performed by residents in training.Another equally important aspect is cost. The authors have not mentioned the difference in cost. For these very reasons, robotic surgery has not gained much interest among our own department faculty since acquiring it 2 years ago.Finally, after their publication, would the authors or the institution continue to encourage robotic surgery for simple atrial septal defects? The article by Bonaros and colleagues [1Bonaros 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] 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 [2Sampath Kumar A. In the fast lane.Ind J Thorac Cardiovasc Surg. 2003; 19: 135Crossref Scopus (2) Google Scholar] are in consonance with the comments of Dr Mack [3Mack M. Invited commentary.Ann Thorac Surg. 2006; 82: 693-694Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Basically any surgical technique for universal adaptability should be better or advantageous in comparison with existing techniques. Being just as good is perhaps not good enough for change. However in this report, by Bonaros and colleagues [1Bonaros 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], the results suggest that the technique is indeed hazardous. Having completed the study, the authors would have done well to compare their robotic technique with their own conventional atrial septal defect closure technique. At our institution the average times for simple atrial septal defect closure are as follows: Most of these procedures are performed by residents in training. Another equally important aspect is cost. The authors have not mentioned the difference in cost. For these very reasons, robotic surgery has not gained much interest among our own department faculty since acquiring it 2 years ago. Finally, after their publication, would the authors or the institution continue to encourage robotic surgery for simple atrial septal defects? ReplyThe Annals of Thoracic SurgeryVol. 84Issue 2PreviewWe would like to thank Dr Kumar [1] 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 [2]. 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 [3]. Full-Text PDF