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Robotically assisted left ventricular epicardial lead implantation for biventricular pacing

Joseph J. DeRose, Jr, MD^*,*, Robert C. Ashton, Jr, MD^*, Scott Belsley, MD^*, Daniel G. Swistel, MD^*, Margot Vloka, MD, FACC, Frederick Ehlert, MD, FACC, Roxana Shaw, PA^*, Jonathan Sackner-Bernstein, MD, FACC, Zak Hillel, MD, PhD and Jonathan S. Steinberg, MD, FACC

^* Division of Cardiothoracic Surgery, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Division of Cardiology, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA
Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York, USA

View larger version (90K): [in a new window]   Figure 1 (A) Photograph of the daVinci Robotic Surgical System showing the surgical arm unit on the left and the surgeon control console on the right. (B) This image demonstrates the EndoWrist instrument capabilities. Each instrument has seven ranges of motion approximating the movement of a human wrist.

View larger version (32K): [in a new window]   Figure 2 Port placement for totally endoscopic, robotic left ventricular epicardial lead placement. The ports are placed in line with the tip of the scapula allowing for posterior access to the left ventricular surface.

View larger version (99K): [in a new window]   Figure 3 Operative photograph of robotic left ventricular lead placement. The pericardium is divided posterior to the phrenic nerve exposing the obtuse marginal (OM) vessels on the posterolateral wall of the left ventricle. A two-turn, helical screw-in lead is being placed by the console surgeon.

View larger version (22K): [in a new window]   Figure 4 Bar graph demonstrating the operative time associated with robotic left ventricular epicardial lead placement. A statistically significant difference in operative time is demonstrated when early and later experiences are compared.