Evaluation of robotic-assisted mitral surgery in a contemporary experience

Abstract

Aims To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program.Methods Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria. We established a dedicated multidisciplinary protocol to facilitate postoperative fast-tracking, and a systematic in-house clinical and echocardiographic follow-up at 3, 6, and 12 postoperative months.Results All patients (89.8% men, average age 58 W 12 years) received mitral valve repair; there was no operative mortality, one conversion to sternotomy (1.7%) and one stroke (1.7%). Extubation within the operative theater occurred in 28.8%; average mechanical ventilation time and ICU stay was 2.8 W 4.1 and 32.5 W 15.8 h (after exclusion of one outlier, learning-curve period, suffering from perioperative stroke); average postoperative hospital stay was 6.8 W 3.4 days and 96.6% of patients were discharged home. One patient was transfused (1.7%); there were no other complications. Follow-up revealed stability of the results of mitral repair, with one (1.7%) persistent (>2R/4R) mitral regurgitation, and stability of coaptation height over time. We observed optimal functional results (NYHA class I was 98% at 3 months and 96% at 12 months). Quarterly case load consistently increased during the experience. ConclusionThis initial experience suggests the reliability and clinical safety of a recently established local roboticassisted mitral surgery. This strategy can facilitate faster postoperative recovery, and its positioning in the therapeutic armamentarium needs to be defined.

Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience

“…Moreover, training and learning curve affect not only surgeons, but also the entire medical team, including nurses, perfusionists and anesthesiologists. For this reason, it is important to create a stable and coordinated surgical team that does not change during the first phase of the program [ 19 ]. Like other authors [ 17 ], we believe that a stable team can affect outcomes and the learning curve itself, which is longer if members change frequently.…”

“…The adopted RAMVS technique has been previously described [ 3 ]. Briefly, an incision of 1.5–2 cm was performed in the third intercostal space for access to the working port, and four other incisions of 0.8 cm were performed as instrumental ports (camera arm, right and left arm, and dynamic left arm).…”

“…In addition, they are equipped with articulated instruments with seven degrees of freedom of movement, thus significantly optimizing dexterity. In this context, MV repair is the perfect and ideal setting for the application of the robotic approach [ 3 ], the safety, efficacy and advantages of which have already been described in the literature [ 3 , 4 , 5 , 6 , 7 ].…”

A cable‐driven soft robotic end‐effector actuator for probe‐based confocal laser endomicroscopy: Development and preclinical validation

“…Breakthrough robotic surgical platforms such as the Da Vinci from Intuitive Surgical were designed initially to focus on general surgical, ear nose and throat and urological procedures where they have seen widespread adoption [1–15]. Neurosurgery is yet to fully embrace robotic surgery for precision tumour resection with a growing interest in paediatrics and epilepsy surgery, but the earliest attempts leveraged the PUMA 560 for brain tumour biopsies [16–22].…”

“…focus on general surgical, ear nose and throat and urological procedures where they have seen widespread adoption [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Neurosurgery is yet to fully embrace robotic surgery for precision tumour resection with a growing interest in paediatrics and epilepsy surgery, but the earliest attempts leveraged the PUMA 560 for brain tumour biopsies [16][17][18][19][20][21][22].…”