Robotically assisted totally endoscopic atrial septal defect repair: Insights from operative times, learning curves, and clinical outcome
Robotically assisted totally endoscopic atrial septal defect repair: Insights from operative times, learning curves, and clinical outcome
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DOI：
10.1016/j.athoracsur.2006.03.024
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发表时间：
2006-08-01
影响因子：
4.6
通讯作者：
Bonatti, Johannes
中科院分区：
文献类型：
--
作者：
Bonaros, Nikolaos;Schachner, Thomas;Bonatti, Johannes
背景远程介入灌注和机器人技术使房间隔缺损和卵圆孔未闭的完全内窥镜闭合成为可能。本研究的目的是在急诊室经验的基础上探讨全内镜下房间隔缺损修补术的学习曲线问题，并研究长时间体外循环和主动脉阻断时间是否会影响术中和术后结局。17例患者（中位年龄35岁;范围16 - 55岁）使用远程访问灌注和机器人技术（da芬奇远程操纵系统）接受了全内窥镜下房间隔缺损修复术。通过对数曲线拟合回归分析评估学习曲线。采用斯皮尔曼rho系数进行线性回归分析手术变量对临床结果的影响。未观察到手术死亡或严重手术并发症。术中或术后超声心动图均未检测到残余分流。观察到总手术时间的显著学习曲线：y（min）= 406 - 49 In（x）（r（2）= 0.725; p = 0.002）;心肺转流时间：y（min）= 225 - 42 ln（x）（r（2）= 0.699; p = 0.003）;主动脉闭塞时间：y（min）= 117 - 25 ln（x）（r（2）= 0.517; p = 0.04），x =手术次数。中位通气时间、重症监护室住院时间和住院时间分别为7小时（范围：2 - 19小时）、26小时（范围：15 - 120小时）和8天（范围：5 - 14天）。体外循环时间与插管时间（r（2）= 0.283; p = 0.326）、重症监护室住院时间（r（2）= -0.138; p = 0.639）或总住院时间（r（2）= 0.013; p = 0.962）之间未检测到相关性。完全内窥镜下房间隔缺损修补术可以安全地进行，手术时间的学习曲线是陡峭的。较长的体外循环时间对术中和术后结局没有负面影响。
Background. Remote access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect and patent foramen ovale. The aim of this study was to address learning curve issues of totally endoscopic atrial septal defect repair on the basis of a singlecenter experience and to investigate whether long cardiopulmonary bypass and aortic occlusion times influence intraoperative and postoperative outcomes.Methods. Seventeen patients (median age, 35 years; range, 16 to 55 years) underwent totally endoscopic atrial septal defect repair using remote access perfusion and robotic technology (da Vinci telemanipulation system). Learning curves were assessed by means of regression analysis with logarithmic curve fit. The effect of operative variables on clinical outcome was analyzed by linear regression using the Spearman's rho coefficient.Results. No operative mortality or serious surgical complications were observed. No residual shunt was detected at intraoperative or postoperative echocardiography. Significant learning curves were noted for total operative time: y(min) = 406 - 49 In(x) (r(2) = 0.725; p = 0.002); cardiopulmonary bypass time: y(min) = 225 - 42 ln(x) (r(2) = 0.699; p = 0.003); and aortic occlusion time: y(min) = 117 - 25 ln(x) (r(2) = 0.517; p = 0.04), x = number of procedures. Median ventilation time, intensive care unit stay, and hospital length of stay were 7 hours (range, 2 to 19 hours), 26 hours (range, 15 to 120 hours), and 8 days (range, 5 to 14 days), respectively. No correlation was detected between cardiopulmonary bypass time and intubation time (r(2) = 0.283; p = 0.326), intensive care unit stay (r(2) = -0.138; p = 0.639), or total length of stay (r(2) = 0.013; p = 0.962).Conclusions. Totally endoscopic atrial septal defect repair can be performed safely, and learning curves for operative times are steep. Longer cardiopulmonary bypass times had no negative impact on intraoperative and postoperative outcome.