Totally Endoscopic Port-Access Artial Myxoma Resection Without Robotic Assistance
The video presents the technique of surgical excision of the
right atrial myxoma using a totally endoscopic port-access without robotic
assistance.
A 51-years-old female was admitted to the hospital because of chest pain just
one day before. She had a normal medical history. Transthoracic
echocardiography revealed a giant neoplasm in the right atrium, a mass
measuring 48x36 mm had a stalk attached to the interatrial septum. The computed
tomography for metastatic workup was negative.
Because the tumor was mobile, moved deeply into the right ventricle during
diastole that led to high risk of pulmonary embolism, so she had underwent an
urgent operation, using the technique of totally endoscopic port-access. The
surgical manipulations were done through 3 trocars <1.2cm, under 3D video
screen.
The patient was placed in supine position, under general anaesthesia with
double-lumen endotracheal intubation. The right side of the chest was slightly
elevated at 300, two arms along the body. External defibrillator patches were
placed to subtend the maximum cardiac mass
A 2 cm tranverse incision was made in the right groin and vessel cannulas
were established with indirect artery cannulation via a Dacron graft (8mm in
diameter), anastomosed end-to-side to the right common femoral artery. Venous
drainage with bicaval cannulation was performed via the right femoral vein and
right internal jugular vein, using Seldinger technique.
Three trocars were placed in the right chest of the patient: one 10 mm trocar
in the 5th intercostal space (ICS) at midaxillary line for the 3D camera, one
12-mm trocar in the 5th ICS between anterior axillary line and midclavicular
line for main surgical instruments (electrosurgical knife, needle holder,
scissors…), one 5-mm trocar in the 4th ICS at anterior line for secondary
instruments.
CPB was initiated, CO2 inflowed into the chest cavity. After lung deflation,
the pericardium was opened 2 cm anterior to the phrenic nerve and 2-0 polyester
traction sutures were made. Superior vena cava was snared using a perlon suture
thread size 2, passed out through the 5mm trocar, IVC was left free. Patient
was in Trendelenburg position. Right atriotomy was performed and 4-0 prolene
atrial wall traction sutures were made for tumor exposure.
Exposure revealed a mass soft, gelatinous, reddish brown, sphere in shape,
smooth surface with estimated dimensions of 5 cm, attached to the fossa ovalis
and completely detached from the septal tricuspid annulus.
A nylon bag was put into thoracic cavity via 12mm trocar, preparation for tumor
harvest. After the tumor was located, the tumor was meticulously and completely
resected from the interatrial septal attachment, delivered into the nylon bag,
The heart chambers were carefully inspected with the 3D endoscope to ensure
complete tumor removal without any debriment residues
The right atriotomy was closed using double-layer continuous 4/0 prolene
running sutures.
Closed the pericardium with continuous stiches, 18Fr drain was placed in
pericardial cavity
Withdrew the 12mm trocar, the tumor containing nylon bag was pulled out through
12mm trocar hole (after extraction in reducing tumor volume).
The 32 Fr pleural cavity drain was inserted through the 10 mm trocar position.
The total operative time and bypass time was 120 minutes and 45 minutes,
respectively.
Postoperative mechanical ventilation: 10 hours, ICU time: 20 hours .
Postoperative drainage in the first 24 hours was 50 ml. The postoperative
hospital stay was 6 days. The pathologic examinations confirmed myxoma.
The authors hope the video would be useful to you. Do not hesitate to contact
us (via email bacsyhuu@gmail.com
or Telephone +84 912168887) if you have any questions about this video.
Thank you!
References
1. Han Li et al. Clinical Features and Surgical Results of
Right Atrial Myxoma. J Card Surg 2016;31
2. Quang-Huy Dang . Totally Endoscopic Resection of Giant Left Atrial Myxoma
without Robotic Assistance. Innovations 2018;13
3. Gao et al .Excision of atrial myxoma using robotic technology. J Thorac
Cardiovasc Surg 2010;139
4. Totally Endoscopic Robotic Cardiac Tumor Resection (Atrial Myxoma). https://roboticheartsurgeon.com/robotic-atrial-myxoma-surgery/