This is a case presentation of a left atrial appendage closure (LAAC) using the Xi robotic system. The indication for the procedure was an elevated ChADVASC score and a contraindication to anticoagulation. The patient was placed supine with the left arm allowed to fall back to expose the left axilla. A left-sided double lumen tube was used. Transesophageal echocardiography was used intraoperatively to rule out LAA thrombus and to assess the LAAC.
The majority of the 25 patients that the authors have treated to date were referred with a history of gastrointestinal or intracranial bleeding. Some were quite frail or had Parkinson's disease and were at risk of falling. The initial series of patients was done thoracoscopically. The authors began to use the robotic system when it was possible to deliver the Atriclip through a 12 mm port, thus allowing CO2 insufflation pressure to be more effectively maintained. This video shows the first case done using a robotic approach.
I would applaud the authors for submitting a nice video showing use of the atricure device to close the LAA using the Da Vinci Xi system. That being said, I don’t think bipolar forceps are needed to open the pericardium. Either monopolar bovie or bipolar scissors would be much faster. Also, I would emphasize the use of TEE to verify complete obliteration of the LAA prior to release of the clip. I use a method I learned from Sam Balkhy at Univ of Chicago where we use 1-3 simple endoloops to obliterate the appendage. The advantage of this is reduced cost, simplicity, and it can be delivered through the 8 mm robotic port (the atricure device requires a bigger incision).
Great suggestions. Thx