Robotic mitral valve repair: experience with the da Vinci system

Nifong, L. Wiley; Chu, Victor; Bailey, B.Marcus; Maziarz, David M.; Sorrell, Vincent L.; Holbert, Donald; Chitwood, W. Randolph

doi:10.1016/s0003-4975(02)04554-x

Cited by 183 publications

(98 citation statements)

References 16 publications

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“…As a result, patient and surgeon satisfaction are guaranteed. Although the technique uses 2-dimensional images as opposed to 3-dimensional images in robotic surgery [22][23][24] , we never felt the necessity of a robot to perform minimally invasive mitral valve surgery. Both techniques use a working-port for ring or valve prosthesis insertion in addition to additional ports for camera and left ventricular decompression.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

et al. 2003

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Background— There is an increasing interest in minimally invasive cardiac surgery. Methods and Results— Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery (226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5±12.9 years. Median preoperative functional class (MVP+MVR) and mitral regurgitation (MVP) were II and 4+. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6±17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91±3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation (MVP) of 0 and a small paravalvular leak in four patients (MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks. Conclusions— Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.

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Section: Discussionmentioning

confidence: 99%

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

et al. 2003

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“…23) Two subsequent studies demonstrated that robotic mitral valve surgery is safe, the short-term results are excellent, and the mid-term durability is good. 24,25) The FDA approved the da Vinci surgical system for mitral valve surgery and atrial septal defect (ASD) repair in November 2002. Mitral valve surgery was accomplished through the same small thoracotomy incisions as the MICS procedure, since the surgical robot allowed the surgeons to complete complex maneuvers.…”

Section: Mitral Valve Surgerymentioning

confidence: 99%

Robot-Assisted Cardiac Surgery

Ishikawa

Watanabe

2015

ATCS

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The significant advantages of minimizing surgical trauma, such as reduced pain, shorter hospital stays, faster return to normal activities, and improved cosmesis, have resulted in the development of minimally invasive surgery. 1) Until recently, various difficulties associated with endoscopic approaches had stalled similar progress in the field of cardiac surgery. However, robotic technology overcame the difficulties associated with conventional endoscopic surgery and has made possible a new approach to minimally invasive cardiac surgery.The application of robot-assisted coronary surgery ranges from internal mammary artery (IMA) harvesting with handsewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB) either on-or off-pump. The bilateral IMAs can be harvested with the aid of a surgical robot, and then multivessel bypass grafting can follow. Srivastava calls such robot-assisted minimally invasive direct coronary artery bypass grafting (MIDCAB) "ThoraCAB.'' 2) Surgical robots can not only endoscopically harvest the IMA, but they can also anastomose the coronary artery in TECAB.On the other hand, closed-chest cardiopulmonary bypass (CPB) and cardioplegic arrest have stimulated the development of minimally invasive cardiac surgery (MICS) via a small thoracotomy, 3) and this has now become universal, especially to treat valve diseases and congenital structural heart diseases. Endoscopic techniques are also required for MICS, but conventional endoscopic instrumentation lacks the dexterity required for delicate cardiac surgical procedures, and the loss of depth perception caused by twodimensional monitors further increases operative obstacles.Surgical robots have been developed to enhance surgical ability and precision, and to repair structural heart conditions, including mitral valve plasty (MVP), atrial septal defect closure, cardiac tumour resection, ThoraCAB, and TECAB. The most common applications in cardiac surgery are MVP and endoscopic coronary artery bypass grafting (CABG). da Vinci Surgical SystemThe da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) comprises a surgeon's console, a Robot-Assisted Cardiac SurgeryNorihiko Ishikawa, MD, PhD and Go Watanabe, MD, PhD Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardi...

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“…In a Food and Drug Administration safety and efficacy trial in 2000 involving 20 patients, Nifong and coworkers 3 used robotic technology to perform a wide spectrum of mitral valve repair procedures. Although cross-clamp and operative times were longer in comparison with the conventional mediasternotomy approach, the morbidity and mortality was similar and the mean hospital length of stay (LOS) was only 4 days.…”

Section: Article See P 1961mentioning

confidence: 99%

Robotic Mitral Valve Repair for Degenerative Mitral Valve Regurgitation

Lazar

2015

Circulation

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Robotic mitral valve repair: experience with the da Vinci system

Cited by 183 publications

References 16 publications

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

Robot-Assisted Cardiac Surgery

Robotic Mitral Valve Repair for Degenerative Mitral Valve Regurgitation

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