Kyobu geka. The Japanese journal of thoracic surgery
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The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. ⋯ Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.
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Endovascular aneurysm repair has brought revolution in the treatment of aortic disease. Although surgical treatment for thoracic aortic aneurysm impose large invasiveness on patients of aged population, endovascular aneurysm repair supply extreme less-invasive treatment for patients with thoracic aortic disease, because of unnecessary for thoracotomy and extracorporeal circulation. Thoracic endovascular aneurysm repair will have further applications and distributions with development and improvement of the device.
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Somatosensory evoked potential (SSEP), evoked spinal cord potential (ESCP) and motor evoked potential (MEP) have been used to detect spinal cord ischemia during aortic surgery. SSEP evaluates the sensory pathway, and is recorded from the sensory cortex by peripheral nerve stimulation. The interval from the onset of ischemia to change is relatively long(5-10 minutes). ⋯ It evaluates motor pathways from the cortex to the muscle, and therefore is influenced by non-spinal factors such as peripheral nerve ischemia. Its vulnerability to anesthesia requires special anesthetic consideration, and baseline amplitude fluctuation is common. It is highly sensitive and shows changes in the early phase of spinal cord ischemia.
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Cerebral ischemic events remain a major problem in patients undergoing cardiac and thoracic aortic surgery. Efforts to improve outcomes have been made in many aspects which include cerebral monitoring. ⋯ Cerebral oxymetry probably is the most commonly used method among these based on its simplicity and reproducibility. Though it is easy to obtain numbers from cerebral oxymetry, it is important to understand the principle and the limitations to interpret the results, properly.