Combined robot‐assisted mitral valve plasty and Nuss procedure via small ports

Abstract

Pectus excavatum (PE) can be associated with cardiac disorders that also require surgical repair. Totally endoscopic robot‐assisted mitral valve plasty for mitral valve regurgitation was performed while elevating the sternum with the aid of our original electrical sternum lifting system. Then, the Nuss procedure was performed successfully via small incision. Simultaneous robot‐assisted cardiac surgery and the Nuss procedure is effective. Sternal elevation during cardiac surgery is very important for a safe procedure. The Nuss technique prevents perioperative cardiac compression and allows for correction of the pectus deformity with good cosmetic and functional results.

Combined minimally invasive repair of pectus excavatum and robotically assisted mitral valve repair: A case report and considerations

“…In this series, the bars were placed after the robotic repair (to avoid interference between the bars and access incision or port sites) and during the repair, the sternum was elevated with a proprietary lowprofile electric sternal elevation system via a subxiphoid incision. 2 In our case, the degree of sternal concavity was more extreme, and we wished to avoid risk of potential collision of the robotic arms with the retraction system or unanticipated fracturing of the sternum, with attendant sudden release of the sternum to its preoperative state during valve repair. Instead, through careful multidisciplinary planning in the placement of the access sites and bar positions, the robotic portion of the case could proceed in an essentially routine fashion.…”

“…PE is commonly associated with cardiac anomalies. In patients with PE and mitral regurgitation, the two conditions can be corrected concomitantly 2 or in two staged procedures 3 . Either way, correction of severe PE before or with valve repair may reduce patients' long‐term symptoms and deleterious effects of cardiac compression 4 …”

“…A series of three cases with Haller index (5.2–5.4) demonstrated the possibility of repair of both lesions with initial external sternal elevation and robotic repair followed by bar placement in the same setting. In this series, the bars were placed after the robotic repair (to avoid interference between the bars and access incision or port sites) and during the repair, the sternum was elevated with a proprietary low‐profile electric sternal elevation system via a subxiphoid incision 2 . In our case, the degree of sternal concavity was more extreme, and we wished to avoid risk of potential collision of the robotic arms with the retraction system or unanticipated fracturing of the sternum, with attendant sudden release of the sternum to its preoperative state during valve repair.…”

Sternal lifting technique for patients with sternal depression during robotic mitral repair

“…[2][3][4][5][6][7] We also operate simultaneously only in mitral regurgitation with severe PE, which is an indication for surgery. 8 Technically, it is possible to perform mitral valve surgery through a sternotomy if the sternal depression is mild. In the presence of moderate to severe thoracic deformity, sternal depression may limit the exposure of the operative field and complicate the surgical approach to the mitral valve.…”

“…In adult patients without severe cardiopulmonary dysfunction, mitral valve surgery can be performed via sternotomy or thoracotomy and does not require repair of the sternal deformity 2–7 . We also operate simultaneously only in mitral regurgitation with severe PE, which is an indication for surgery 8 …”