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ISMICS 2023 Annual Meeting
31 May - 3 June, 2023 | Boston, MA
PC36
Routine Use Of An Airseal® Utility Working Port In Robotic Cardiac Surgery: A Case Series
Poster Presenter
Authors
Jenna Mandel, Jake Rosen, Michelle Schafer, Kellen Round, Colin Yost, Kyle Prochno, T. Sloane Guy
Affiliations
Part of Topic
Valve - Surgical Valves
Routine use of an Airseal® Utility Working Port in Robotic Cardiac Surgery: A Case Series
Jenna Mandel BS1, Jake L. Rosen BA1, Michelle Schafer1 , Kellen Round BS1, Colin C. Yost BA1, Kyle W. Prochno BA1, T. Sloane Guy MD, MBA2
Introduction:
•AirSeal® iFS is a valveless trocar that enables stable pneumoperitoneum with continuous smoke evacuation during laparoscopic and robotic surgeries.
•To our knowledge, its use has not yet been described for robotic cardiac procedures.
•We seek to demonstrate the use of AirSeal® iFS for robotic cardiac surgery and suggest it may offer a safe alternative to standard CO2 insufflation.
Methods:
•A retrospective analysis of 125 patients who underwent robotic cardiac surgery at a single institution with the use of AirSeal® iFS between July 2019 and April 2022 is described.
•Preoperative, intraoperative, and postoperative data were collected and are detailed.
•Continuous variables are reported as median [interquartile range], and categorical variables are presented as percentages of the total number of patients included (n/N).
Surgical Approach:
•The right lung is deflated
•An 8 mm robotic camera port is placed in the right 4th or 5th intercostal space anterior to the anterior axillary line
•The pleural space is then inspected to ensure avoidance of adhesions if present
•The remainder of the ports are placed under camera vision including an 8 mm robotic right arm port, 8 mm left arm camera port, and an 8 mm working port.
Outcomes:
| Patient Characteristics | AirSeal® Insufflation |
| (n=125) | |
| Age, years (median, IQR) | 64.5 [55, 72] |
| Male (n, %) | 83 (66.4) |
| Body Mass Index (median, IQR) | 25.7 [23, 30] |
| Hypertension (n, %) | 85 (68) |
| Coronary Artery Disease* (n, %) | 33 (26.4) |
| Peripheral Artery Disease (n, %) | 7 (5.6) |
| Atrial Fibrillation (n, %) | 43 (34.4) |
| Heart Failure (n, %) | 27 (21.6) |
| Ejection Fraction (median, IQR) | 62 [57, 65] |
| Endocarditis (n, %) | 9 (7.2) |
| Current Smoker (n, %) | 10 (8) |
| Chronic Lung Disease (n, %) | 26 (20.8) |
| Diabetes Mellitus (n, %) | 11 (8.8) |
| Renal Failure (on dialysis) (n, %) | 3 (2.4) |
| Prior Myocardial Infarction (n, %) | 8 (6.4) |
| Prior Cerebrovascular Accident (n,%) | 9 (7.2) |
| Prior Cardiac intervention (n, %) | 40 (32) |
| COVID-19 positive prior to hospitalization (n, %) | 11 (8.8) |
Operative Details:
| Variable | AirSeal® Insufflation |
| (n=125) | |
| Mitral Valve Repair (n,%) | 25 (20) |
| Mitral Valve Replacement (n, %) | 5 (4) |
| Tricuspid Valve Repair (n, %) | 6 (4.8) |
| ASD Repair (n, %) | 2 (1.6) |
| PFO Repair (n, %) | 0 (0.0) |
| LAA Closure (n, %) | 95 (76) |
| CPB Time, minutes (median, IQR) | 113.5 [98, 134] |
| Aortic Cross-Clamp Time, minutes (median, IQR) | 67.5 [72, 85] |
| Blood Products Given (n, %) | 37 (29.6) |
Outcomes at 30-Days:
| Postoperative Events | AirSeal® Insufflation |
| (n=125) | |
| Readmission to ICU (30-day) (n,%) | 1 (.8) |
| Blood products given (n,%) | 62 (49.6) |
| Surgical Site Infection (n) | 0 (0.0) |
| Ejection Fraction (median, IQR) | 60 [55, 65] |
| Hospital Events (n,%) | 24 (19.2) |
| Prolonged Ventilation (n,%) | 3 (2.4) |
| Cardiac Arrest (n,%) | 1 (.8) |
| Atrial Fibrillation (n,%) | 12 (9.6) |
| 30-day mortality (n, %) | 1 (.8) |
Conclusions:
•In this single-center case series, our findings suggest that use of AirSeal® iFS during robotic cardiac surgery may be a safe and promising alternative to standard CO2 insufflation.
•Future studies are needed to elicit if AirSeal® iFS provides increased benefit in outcomes and safety when compared to current stand approaches in robotic cardiac surgery.