Surgery Today

, Volume 49, Issue 2, pp 118–123 | Cite as

Three-port totally endoscopic repair vs conventional median sternotomy for atrial septal defect

  • Junji YanagisawaEmail author
  • Atsuo Maekawa
  • Sadanari Sawaki
  • Masayoshi Tokoro
  • Takahiro Ozeki
  • Mamoru Orii
  • Toshiyuki Saiga
  • Toshiaki Ito
Original Article



We assessed the validity of three-port totally endoscopic repair (3PTER) for atrial septal defect (ASD).


Between February, 2000 and November, 2017, 151 patients underwent surgery for ASD. Forty-seven patients underwent 3PTER as minimally invasive cardiac surgery (MICS) and 104 patients underwent conventional median sternotomy (CMS). Propensity matching yielded 94 matched patients (47 vs 47). We compared the early results between the groups. The 3PTER technique was performed with the patient in the partial left lateral position, under cardio-pulmonary bypass (CPB) established through a groin incision. The three ports consisted of a main incision (3 cm), a trocar for the left-handed instrument, and a camera port in right antero-lateral chest.


MICS needed longer cross clamp and CPB times (57, 48–86 vs 24, 16–30 min, p < 0.01 and 115, 106–131 vs 53, 43–80 min, p < 0.01, respectively)*, although the operation time and hospital stay were significantly shorter (180, 159–203 vs 190, 161–225 min, p = 0.024 and 6.0, 6–8 vs 15, 13–19 days, p < 0.01, respectively)*. The intra-operative and postoperative bleeding were significantly less in MICS than CMS (20, 5–40 vs 225, 130–287.5 p < 0.01 and 200, 145–290 vs 340, 250–535 ml, p < 0.01, respectively)*. *: median, 25th–75th percentile.


Irrespective of the longer CPB and cross-clamp time than for CMS, MICS had a shorter operation time, less bleeding, and resulted in quicker recovery. The 3PTER was safe and cosmetically excellent.


Minimally invasive cardiac surgery Atrial septal defect Endoscopic surgery 



This study was performed using the hospital department resources and no funding or Grants were received.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.


  1. 1.
    Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults results of a multicenter nonrandomized trial. J Am Coll Cardiol. 2002;39:1836–44.CrossRefGoogle Scholar
  2. 2.
    Berger F, Vogel M, Alexi-Meskishvili V, Lange PE. Comparison of results and complication of surgical and amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg. 1999;118:674–80.CrossRefGoogle Scholar
  3. 3.
    Ryan WH, Cheirif J, Dewey TM, Prince SL, Mack MJ. Safety and efficacy of minimally invasive atrial septal defect closure. Ann Thorac Surg. 2003;75:1532–4.CrossRefGoogle Scholar
  4. 4.
    Mishaly D, Ghosh P, Preisman S. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg. 2008;85:831–5.CrossRefGoogle Scholar
  5. 5.
    Black MD, Freedom RM, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg. 1998;65:765–7.CrossRefGoogle Scholar
  6. 6.
    Vistarini N, Aiello M, Mattiucci G, Alloni A, Cattadori B, Tinelli C, et al. Port-access minimally invasive surgery for atrial septal defects: a 10-year single-center experience in 166 patients. J Thorac Cardiovasc Surg. 2010;139:139–45.CrossRefGoogle Scholar
  7. 7.
    Yaliniz H, Topcuoglu MS, Gocen U, Atalay A, Keklik V, Basturk Y, et al. Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian J Surg. 2015;38:199–204.CrossRefGoogle Scholar
  8. 8.
    Jung JC, Kim KH. Minimally invasive cardiac surgery versus conventional median sternotomy for atrial septal defect closure. Korean J Thorac Cardiovasc Surg. 2016;49:421–6.CrossRefGoogle Scholar
  9. 9.
    Greinecker GW, Dogan S, Aybek T, Khan MF, Mierdl S, Byhahn C, et al. Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation. J Thorac Cardiovasc Surg. 2003;126:465–8.CrossRefGoogle Scholar
  10. 10.
    Xiao C, Gao C, Yang M, Wang G, Wu Y, Wang J, et al. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg. 2014;19:933–7.CrossRefGoogle Scholar
  11. 11.
    Bonaros N, Schahner T, Oehlinger A, Ruetzler E, Kolbitsch C, Dichtl W, et al. Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learnig curves, and clinical outcome. Ann Thorac Surg. 2006;82:687–94.CrossRefGoogle Scholar
  12. 12.
    Liu G, Qiao Y, Ma L, Ni L, Zeng S, Li Q, et al. Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic da Vinci surgical system. J Cardiothorac Surg. 2013;8:119.CrossRefGoogle Scholar
  13. 13.
    Ito T, Maekawa A, Hoshino S, Hayashi Y, Sawaki S, Yanagisawa J, et al. Three-port (one incision plus two-port) endoscopic mitral valve surgery without robotic assistance. Eur J Cardio Thorac Surg. 2017;51:913–8.CrossRefGoogle Scholar
  14. 14.
    Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, Kobayashi J, et al. Thoracic and cardiovascular surgery in Japan during 2014. Gen Thorac Cardiovasc Surg. 2016;64:665–97.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Junji Yanagisawa
    • 1
    Email author
  • Atsuo Maekawa
    • 1
  • Sadanari Sawaki
    • 1
  • Masayoshi Tokoro
    • 1
  • Takahiro Ozeki
    • 1
  • Mamoru Orii
    • 1
  • Toshiyuki Saiga
    • 1
  • Toshiaki Ito
    • 1
  1. 1.Department of Cardiovascular SurgeryJapanese Red Cross Nagoya First HospitalNagoyaJapan

Personalised recommendations