Thoracoscopic robot-assisted extended thymectomy in the human cadaver.

Methods: Thoracoscopic robot-assisted extended thymectomy was performed in a human cadaver. The technique utilized the da Vinci surgical system inserted through the subxiphoid approach with the sternum lifted upward (anteriorly). A small subxiphoid incision and two additional thoracoports were made in the chest wall, and the sternum was lifted by a new lifting retractor system.

Thoracoscopic robot-assisted extended thymectomy in human cadaver.

Thoracoscopic robot-assisted extended thymectomy was performed in a human cadaver. The technique utilized the da Vinci surgical system inserted through the subxiphoid approach with the sternum lifted upward (anteriorly). A small subxiphoid incision and two additional thoracoports were made in the chest wall, and the sternum was lifted by a new lifting retractor system.

How to do it: importance of left atrial side retraction in robotic and minimally invasive mitral valve surgery.

A customized transthoracic atrial retractor was previously developed for robotic and minimally invasive mitral valve surgery, but it has sometimes failed to provide sufficient exposure of the mitral valve because some atrial tissues push away the operative field from the right side. This report describes 3 new atrial side retractors (the foldaway retractor, the spoon retractor, and the wired retractor) and their use in performing robotic mitral valve repair in fresh frozen human cadavers. These retractors provided exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery in human cadavers without causing traumatic injury, and these retractors should be useful in live patients because they will be used in arrested hearts.

Port-access atrium retractors for totally endoscopic mitral valve surgery: theTornado Retractor, the Butterfly Retractor, and the Semiautomatic Butterfly Retractor.

Introduction: We developed three types of new atrial retractors that facilitate totally endoscopic mitral valve surgery.

Technique: Tornado Retractor: This retractor, which is made of rigid thick wire has a unique appearance, and can be inserted atraumatically through a 3-mm skin incision. Butterfly Retractor: This retractor consists of two parts: a rigid thick rod and foldable blades.

How I do it: self-retaining atrial retractors for robotic and minimally invasive mitral valve surgery.

Successful surgery, particularly on the heart valves, is dependent on excellent and consistent exposure of the operative field. In this report, we describe 2 types of new atrial retractors designed for robotic and minimally invasive mitral valve surgery. These simple and easy-to-handle atrial retractors provide exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery and prevent traumatic injury.

New instrument for robotic-enhanced skeletonized internal thoracic artery harvesting: triangular hook.

Objective: : The introduction of robotic surgery has generated innovations in minimally invasive coronary surgery, including instrumentation. We have developed a small instrument, named by us the Triangular Hook, that expedites robotic skeletonization of the internal thoracic artery and makes the procedure safer.

Methods: : Bilateral skeletonized internal thoracic artery harvesting was performed in four dogs (weight, 22 to 36 kg), using the da Vinci surgical system (Intuitive Surgical, Inc, Sunnyvale, CA).

Mirror glasses for minimally invasive surgery.

Introduction: The operator performing minimally invasive surgery is prevented from seeing the whole field with both eyes by the restricted small thoracotomy incision. To overcome this problem, we developed mirror glasses.

Methods: Use of these glasses was evaluated in terms of the time required for threading of sutures with endoscopic forceps.

Robotic replacement of the descending aorta in human cadaver.

Robot-assisted replacement of the thoracic aorta was performed in a human cadaver. Temporary shunt bypass was established by inserting a left axillary artery catheter and directing it through the aortic arch toward the right femoral artery through the abdominal aorta. The technique utilized the da Vinci surgical system inserted through the 4-cm supramammary working port and two additional thoracoscopic ports.

Thoracoscopic lobectomy with the da vinci surgical system.

Thoracoscopic upper lobectomy has been performed with the da Vinci surgical system in human cadavers. A minithoracotomy and two additional thoraco ports provided access to the thoracic cavity. An auxiliary port was used for both retraction of the lung and suction.

Effect of Vacuum Assisted Closure Therapy on early systemic cytokine levels in a swine model.

Vacuum Assisted Closure (V.A.C.

Acute effects of suction retraction on atrial hemodynamics and histology.

Objectives: In minimally invasive and robotic mitral valve surgery, a blade retractor is used to elevate the left atrial roof, which often distorts tissue and impairs visualization. We tested the hemodynamic and histologic changes of intra-atrial suction, using a new suction retractor that may improve stabilization and visualization.

Methods: Swine were divided into 3 equal (n = 4) groups: blade retractor, suction retractor, and arrested heart control.

Methylene blue enhancement of resuscitation after refractory hemorrhagic shock.

Background: Methylene blue has been used to treat hypovolemic states. This study evaluated prehospital resuscitation after refractory hemorrhagic shock with a combination of methylene blue and limited-volume lactated Ringer's solution.

Methods: After blood loss to a mean arterial pressure of 50 mm Hg in canines, refractory hemorrhagic shock was defined as minimal hemodynamic response to phenylephrine.

Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds.

Background: Application of the Vacuum-Assisted Closure device (VAC) to open sternal wounds has negative hemodynamic effects. We hypothesized that the interposition of a muscle flap attenuates these negative hemodynamic effects.

Materials And Methods: After institutional approval, monitoring lines were placed in anesthetized, ventilated pigs.

Sutureless robot-assisted mitral valve repair: an animal model.

Background: Robotic mitral valve repair with the da Vinci robotic surgical system has been performed in more than 70 patients at our institution. This procedure reduces the need for blood transfusions, shortens hospital stay, and hastens return to normal activities. However, the robot-assisted repair also requires longer cardiopulmonary bypass and arrested-heart times than conventional open repairs.