Optimizing the exposure in minimally invasive mitral surgery: a new left atrial retractor system

Abstract

Optimal exposure of the mitral valve is paramount in minimally invasive surgery (MIS) and a prerequisite for successful mitral valve repair or replacement. We report the concept of a new left atrial retractor (Karl Storz GmbH, Tuttlingen, Germany) dedicated to MIS. The effectiveness of the device was evaluated in a prospective series of 40 patients successfully operated at our institution.

Prediction of poor exposure in endoscopic mitral valve surgery using computed tomography

“…Although this study only targeted patients who underwent EMVS, the results of this study are expected to have significance for all types of minimally invasive MV surgeries, including robotic and direct-vision mini-MV surgery. Although the issue of suboptimal MV exposure during EMVS has been raised previously [ 4 , 5 , 12 , 13 ], few studies have proposed its clear definition, incidence and impact on surgery, largely due to the difficulty in objectively defining poor exposure. However, in our study, the surgical field of view could be recorded and analysed retrospectively by multiple reviewers owing to the use of totally endoscopic surgery.…”

“…Compared to conventional mitral valve (MV) surgery through sternotomy, endoscopic mitral valve surgery (EMVS) through mini-thoracotomy has a faster recovery, shorter hospital stay and better cosmetic effects [ 1–3 ]. In EMVS, optimal exposure is crucial because compared to sternotomy, the size of the working port is much smaller and the space in which the surgical instruments can be moved is greatly limited [ 4 ]. Although EMVS can provide unobstructed indirect vision for MV, it does not guarantee a good surgical exposure in all cases.…”

Innovative techniques of left atrial exposure in minimally invasive mitral valve repair

“…Although those regular trans-thoracic wall retractors are safe and provide stable mitral valve exposure, they also bring a potential risk of injury to the mammary and intercostal vessels during the insertion of the bar. 4 Here, we introduce a simple method that has replaced all of our specialized atrial retractors in MIMVS. The materials used are only 4/0 Prolene sutures, which are widely available.…”

Left atrial anomalous muscular band as incidental finding during video-assisted mitral surgery

“…Technical details and set up of our approach have been previously described (2)(3)(4)(5)(6)(7). After cardio-pulmonary bypass (CPB) was established and cardiac arrest achieved, the left atrium was opened and retracted with adhoc atrial retractor (8). A 10-mm 30-degree optic with 3D-technology was inserted into the pleural cavity.…”