Totally Endoscopic Robotic Cardiac Tumor Resection (Atrial Myxoma)
Tumors in the right or left atria or the ventricles can be removed robotically. The most common example of this would be a benign atrial myxoma. These tumors need removal because they can cause strokes (by breaking off and going to the brain) or obstruct blood flow which can cause heart failure. They can also cause constitutional symptoms such as fatigue, weight loss, weakness, fever, and joint pain. The picture to the left shows an actual atrial myxoma inside a heart. They are often very friable and pieces of tumor and clot that adhere to it can break off and cause strokes or other problems with blood flow to various parts of the body.
Leaving a myxoma in the heart is not a good plan except in very high-risk patients, especially given how easily it can be removed in most cases. Over time, myxomas will typically grow which increases the risk of stroke and obstruction of blood flow. There is a condition called “Carney’s Syndrome” where patients develop multiple myxomas over time. These tumors should also be removed in most cases.
Animation of Robotic Atrial Myxoma Resection
Watch this video on YouTube.
The totally endoscopic approach is ideal for such cardiac tumor removal. The tumor (often an atrial myxoma) is removed endoscopically using a bag to contain it. The procedure is performed very much like robotic mitral or tricuspid valve surgery and is done through small incisions under the right armpit lateral to the breast. The biggest chest incision is the working port which is 15 mm in size (1.5 cm or very small as seen in the diagram to the right. Most surgeons removal such tumors through a median sternotomy (or splitting of the breastplate). Some remove them using a right thoracotomy or larger cut in the chest under the right breast. Although we respect surgeons and patients who use the options, we feel strongly a totally endoscopic approach provides the same level of effectiveness but is far less invasive.
The procedure does require cardiopulmonary bypass but we use a peripheral catheter-based system to accomplish this and avoid traditional sternotomy. The tumor is resected and removed using an “endo-bag” to avoid any potential fragments from remaining in the patient. Most of these tumors are benign atrial myxomas (not malignant or “cancer”) but still need to be removed because they can cause heart failure, death, or stroke depending on their size and location.
These tumors can occur in any location of the heart but are most frequently in the left atrium. However, tumors of the right atrium, right ventricle, and left ventricle can also be resected using totally endoscopic robotic techniques. Even resection of a tumor of the aortic valve has been performed. The superior visualization that the robotic platform gives the surgeon allows for very precise resection.
The truth is that a sternotomy (breastplate sawed in half to gain access to the heart) is simply not necessary to remove these tumors. The robotic system can access resectable tumors of any of the heart chambers (usually the left atrium) and can be used by the surgeon to remove them.
See video below of a totally endoscopic robotic atrial myxoma (benign tumor) resection by Dr. T. Sloane Guy, MD.