Robotically Controlled Video-Assisted Port-Access Mitral Valve Surgery

Abstract

From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 +/- 1.2 hours, aortic crossclamp time was 58 +/- 16 minutes, intensive care unit stay was 22 +/- 7 hours, and hospital stay was 6.4 +/- 1.2 days. Median postoperative blood loss was 332 +/- 104 mL. There was 1 hospital death. On follow-up at 16.4 +/- 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 +/- 0.5 to 1.4 +/- 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.

Recent Trends in Minimally Invasive Cardiac Surgery

“…Patient satisfaction and recovery have been excellent in our patients. Other groups have published similar results using AESOP minimally invasive mitral surgery [31, 32]. …”

Anesthetic Challenges in Minimally Invasive Cardiac Surgery

“…Since its inception, RACS has found its role mainly in coronary artery bypass grafting (CABG) surgery, mitral valve repairs (MVR), and atrial septal defect (ASD) closures. [5][6][7] Of late, procedures such as maze procedure for atrial fibrillation, intracardiactumor resection, and some congenital heart surgeries such as patent ductusarteriosus (PDA) ligation and transatrial repair of tetralogy of Fallot have also been done with robotic assistance. Continued improvements in surgical telemanipulation systems and intelligent robotic-enhanced instruments have made it possible to perform RACSs with pinpoint precision.…”