Robotic Excision of a Large Left Atrial Myxoma

Seven robotic left atrial myxoma resections were performed so far in the authors’ institution. The patients had no stroke or bleeding complications, and all were discharged home after a mean period of seven days.

Key messages

The authors’ normal preoperative workup consists of a coronography, a TEE to further delineate the anatomy of the myxoma and its relationship with the mitral valve, and a CT aortogram to check for calcifications of the ascending aorta (the authors use the Chitwood aortic clamp to cross-clamp the aorta) and to ascertain the suitability of peripheral vessels for cardiopulmonary bypass institution.

Similar to robotic mitral valve surgery, robotic myxoma excision is a two-surgeon procedure (console and bedside surgeon). Patient and ports positioning during surgery are key to the procedure’s success, as demonstrated in the video.

The unique features of the robot instruments and the excellent 3D view largely facilitate the removal of the myxoma in its entirety without fragmentation, even in very large tumors. Often, a sterile plastic retrieval-bag is required to remove the myxoma safely through the small thoracotomy.