Routine Endoscopic Robotic Cardiac Tumor Resection using an 8 mm Working Port and Percutaneous Cannulation
Jake L. Rosen1, Colin C. Yost1, Daniella H. Wong, MD1, Jenna L. Mandel1, Kyle W. Prochno1, Caroline M. Komlo, MD2, Nathan Ott, MD1, Thomas S. Guy, MD, MBA3.
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA, 2Yale New Haven Hospital, New Haven, CT, USA, 3Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
OBJECTIVE: We report our unique initial experience in robotic cardiac tumor removal. This is one of the first extensive reports demonstrating cardiac myxoma/fibroelastoma removals with use of exclusively 8-mm ports, making these resections some of the least invasive to date.
METHODS: All data were retrospectively collected from 2019 - 2022. 20 tumor resections were performed, 18 done robotically. 13 myxomas and 5 fibroelastomas were resected. Pre-, intra-, and post-operative data were recorded. Continuous variables were reported as median [IQR] and categorical variables in percentages.
RESULTS: Median patient age was 64.0 [55.3, 70.3] years. All patients underwent myxoma/fibroelastoma removal with use of five 8-mm robotic ports and percutaneous femoral arterial cannulation. Aortic occlusion was achieved via use of balloon occlusion (67%) or cross-clamping (33%). Concomitant procedures were performed during myxoma resection (Table 1).
Upon resection, tumors were packaged with the endo-bag and removed through the working port. Maximal myxoma and fibroelastoma diameters were 2.5 [1.7, 3.5] and 0.6 [0.4, 0.7] cm, respectively. Procedural cardiopulmonary bypass and cross-clamp times were 76.50 [65.3, 83.8] and 29.5 [25.5, 40.5] minutes. No postoperative adverse events related to the index procedure occurred, although one patient died in the context of a hypercoagulable state unrelated to their operation. Hospital length of stay was 4.50 [3.00, 7.75] days.
CONCLUSIONS: In our retrospective review, the robotic platform facilitated safe and effective cardiac tumor excision. Our results highlight the efficacy of 8-mm port sizing and the concurrent use of other minimally invasive techniques, including percutaneous cannulation, in this patient population.
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