Developments in robotic cardiac surgery.

A new generation of surgical telemanipulation systems has helped to overcome the limitations of conventional endoscopic tools. These computer-enhanced instrumentation systems provide tremor filtering and motion scaling and allow dexterous manipulations in confined spaces through ports or trocars. Using these systems, total endoscopic coronary artery bypass grafting both on the arrested and on the beating heart has been performed successfully. Repair of mitral valves as well as atrial septal defects has also been performed remotely through 1 centimeter incisions. Despite some early procedural success, operating times are prolonged and a number of conversions have been reported. Currently, the use of telemanipulation systems is restricted to selected patients and limited to very few indications. Further refinements in telemanipulator technology as well as integration of image-based navigation systems may expand the use of computer-enhanced instrumentation systems in the near future.