Robotic mitral valve surgery: overview, methodology, results, and perspective

Abstract

Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author's series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the "heart team" approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. Keynote Lecture SeriesHe who is fixed to a star does not change his mind.--Leonardo da Vinci Evolutionary overviewWith the development and improvement of endoscopic vision in the late 1970s, the notion of laparoscopic operations was spawned and then developed rapidly, despite early reservations by most surgeons. This skepticism was gradually overcome as many traditional general surgical, gynecological and urological operations were replaced rapidly by less invasive and/or endoscopic operations. During this era, cardiac surgery had evolved so well using sternotomy incisions that there seemed to be no incentive for cardiac surgeons to adopt either secondary vision or less invasive incisions. Non-cardiac thoracic surgeons were the first to embrace this disruptive methodology and they proved that major pulmonary operations could be done safely and effectively using thoracoscopic techniques. The idea of minimally invasive cardiac surgery emanated from the "Heartport Era" with the development of new innovative aortic occlusive devices, long-shafted instruments and ports for cardiac access (1,2). These developments issued the clarion call that minimally invasive cardiac surgery was possible and that surgeons must begin

Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach

“…The benefits of robotic cardiac surgery have been established and amply described . Robotic cardiac surgery allows for excellent visualization of intra and epicardial structures.…”

Five Maneuvers to Facilitate Faster Robotic Mitral Valve Repair

“…1 High-volume centers report exceptional outcomes with minimal morbidity and mortality in select patient populations. 1,2 Compared to conventional sternotomy, robotically assisted surgery yields comparable efficacy and safety, with potential benefits of improved cosmesis and a faster recovery period. 1,3 Despite the potential benefits of a robotic approach, there has been a reluctance in widespread adoption due to concerns over cost, procedural complexity with a steep learning curve, and safety and durability of repair.…”

Control of continuum robots for minimally invasive interventions

“…Tangible improvements in MIS are offered by technological advances in continuum robotics such as steerable and flexible needles, delivery sheaths, endoscopes, laparoscopic devices and catheters, which are often assisted by sensorguided control [20]. By considering percutaneous MIS, improvements have been provided by continuum robots such as steerable and flexible needles [21].…”

“…The initial target locations for experimental Scenarios I-A, -B, -C and -D are (100,−20,10), (100,20,10), (100,−20,−10) and (100,20,−10), respectively. The initial target location for experimental Scenarios II-IV is (100,−10,−10).…”

“…As an alternative to sternotomy incision procedures, MV repair treatment with reduced patient trauma could be provided by minimally invasive surgery (MIS) [15]. The favorable long-term outcome provided by MV repair strategies with reduced patient trauma, requires an increase in MIS capability, which can be offered by (robotic) catheter integration [20,148]. The development of robotic catheters for cardiovascular applications have 5.1.…”