Unilateral Thoracoscopic Microwave Ablation Procedure

By Daniel J. Beckman, MD

Editor's Note

This is an elegant video clearly portraying the feasibility of pulmonary vein isolation through a thoracoscopic approach.  Given the ease with which the authors have performed this procedure – obviously assuming that they went through a learning curve prior to mastering the technique – the first question that comes to mind is whether there is any advantage to a robotic approach for this procedure.   It appears that the three dimensional vision and fine motor coordination that the robot provides may be unnecessary for this procedure.

The second question that comes to mind arises from the fact that no accurate mapping on the left side (such as high frequency pacing and sensing from various locations around the pulmonary veins and the ligament of  Marshall) can be performed when a unilateral approach is chosen (robotic or thoracoscopic).  In addition, there is no possibility of stapling the left atrial appendage, a practice that can prove neuroprotective to the patient even if the ablation fails.  Is the surgical trauma of an additional left thoracoscopy so severe as to warrant foregoing accurate left sided mapping and left atrial appendage stapling?

George Tolis Jr., MD

Author's Disclosure Statement

I, Daniel J. Beckman, M.D., have been a scientific consultant to Boston Scientific. 

Video: