Totally Endoscopic Robotic Surgery for Atrial Fibrillation

Robotic Cryomaze Procedure. Click to enlarge.

Using techniques similar to that for mitral valve repair, a “MAZE” procedure can be performed to treat atrial fibrillation either alone or with a mitral valve operation.  This can be done in many different ways, but I prefer a totally endoscopic cryo-maze approach.  This approach and technology reproduce the important lesions originally described by Dr. Cox who designed the procedure upon which all atrial fibrillation procedures (both catheter and surgery) are based upon.  I believe that this gives you the best chance of being successfully put into sinus rhythm short of the original “cut and sew” method that requires a sternotomy (breastplate division).

Totally endoscopic robotic ports for atrial fibrillation surgery with or without mitral valve procedures.

Totally endoscopic robotic ports for atrial fibrillation surgery with or without mitral valve procedures. Click to enlarge.

This procedure is performed through very small incisions similar to what we do for robotic mitral valve surgery (often it is performed at the same time as mitral valve surgery).  We do perform isolated maze procedures in the same way.  Our philosophy is that if a patient is going to subject themselves to surgery, however minimally invasive, they should get as close to the “gold standard” in surgical ablation as possible.

The Cox-Maze procedure has been shown to be very effective at curing atrial fibrillation.  However, there is great variation in what surgeons perform and call a Maze procedure.  Therefore there is a lot of variation in results.  What is important to know is whether or not a surgeon is going to perform a complete or incomplete lesion set and do only the left atrial or both the right and left atrial lesions.  I do a complete MAZE procedure including both right and left atrial lesion sets except in cases of paroxysmal atrial fibrillation (comes and goes) where a left-sided lesion set performs equally well or a high-risk patient where I want to limit the risk to the patient.

One question that comes up a lot is why does a patient need to be on blood thinners if they have atrial fibrillation.  The reason is that when the blood is static (not moving) in the left atrium which results from lack of normal contraction of the atrium, a clot can form which can break off and cause a stroke (block off blood flow to part of the brain).

Below is a video of a robotic totally endoscopic MAZE procedure performed by Dr. Guy.

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T. Sloane Guy, MD

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