Use of Detachable Aortic Cross Clamp for Robotic Cardiac Surgery
Options for aortic occlusion during robotic cardiac surgery include endoaortic balloon occlusion, which requires imaging guidance and coordination between the bedside assistant and anesthesia teams; the Chitwood DeBakey transthoracic clamp, which requires a separate incision and can lead to interactions between the clamp and robotic arms; and more recently, a detachable head aortic cross-clamp. The detachable head clamp can be easily applied by the bedside assistant through the standard working port and eliminates the possibility of interaction between the clamp and robotic arms during the operation.
This video demonstrates the use of a detachable head aortic cross-clamp for robotic cardiac surgery. The procedure began by assessing the anatomy of the transverse sinus and ensuring that there were no adhesions. The clamp head and delivery device were then advanced through the working port and the lower jaw was inserted through the transverse sinus. The clamp head was then closed and released.
During the operation, retraction of the left atrium lifted the clamp head out of the way and prevented interaction with the robotic arms.
At the end of the operation, a silk tie, which had already been fastened to the clamp head, was used to position the device for retrieval. The delivery device was then reattached and the clamp head was removed.
Bates MJ, Chitwood WR. Minimally invasive and robotic approaches to mitral valve surgery: Transthoracic aortic crossclamping in optimal. JTCVS Techniques. 2021;10:84-8.