Robotic Application of an AtriClip for Chronic Atrial Fibrillation

Nice video. What was the issue with a Watchman exactly? Also since you used 4 ports, you could have used the 4th arm to retract the lung in the beginning

The authors are to be congratulated for their video on the 1st robotic application of an AtriClip in United Kingdom and Europe. This video is an excellent demonstration of the robotic application of a left atrial clip. I believe the robotic approach allows a stable platform allowing a more precise flush application of the clip. In addition, the lateral decubitus position allows the heart to rotate away, allowing entrance into the pericardium posterior to the phrenic nerve providing a better exposure of the base of the left atrial appendage. Utilizing 4 ports for the robot allows the 4th arm to retract the left upper lobe through the fissure with a tip up fenestrated grasper. I prefer the Pro V Clip because of the open tip allowing easier application and better visualization of the tip and base to allow flush exclusion. The small grasping retractor allows gentle grasping of the appendage to be safely pulled into the clip once the clip is in place and prior to securing. At The Heart Hospital Baylor Plano, we have robotically applied a left atrial clip in 64 patients. The average operative time is 73 minutes, and most patients go home the following day. Flush exclusion of 95% has been confirmed by CTA heart or echocardiogram at six months. Robotic application of a left atrial clip is the preferred approach and can be combined with concomitant procedures.