Robotic mitral valve surgery: a review and tips for safely negotiating the learning curve

Abstract

Totally endoscopic robotic mitral valve repair represents the least invasive surgical therapy for mitral valve disease. Comparative results for robotic mitral valve surgery against sternotomy are impressive, repeatedly demonstrating shorter hospital stay, faster return to normal activities, less morbidity and equivalent mortality and mid-term durability. We lack data comparing robotic approaches to totally endoscopic minimally invasive mitral valve surgery using 3D vision platforms. In this review, we explore the advantages and disadvantages of robotic mitral valve surgery and share technical tips that we have learned to help teams embarking on their robotic journey. We consider factors necessary for the successful implementation of a robotic programme including the importance of training a dedicated team, with the common goal to avoid any compromise in either patient safety or repair quality during the learning curve. As experience grows with robotic techniques and more cardiac surgeons become proficient with this innovative technology, the volume of robotic cardiac procedures around the world will increase helped by the introduction of new robotic systems and patient demand. Well informed patients will increasingly seek out the opportunity of robotic valve reconstruction in reference centres in the hands of a few highly experienced robotic surgeons.

Keywords: Mitral valve; minimally invasive; outcomes; robotics.

Figure 1

The da Vinci Xi (reproduced with permission from Intuitive Surgical).

Figure 2

The LEAR Technique (Lateral Endoscopic Approach for Robotics). A, access port; E, endoscope port; L, left arm port; LA, left atrial retractor port; R, right arm port.

Figure 3

The operative view with the da Vinci.

Figure 4

Indocyanine green fluorescing in the IntraClude in the mid ascending aorta.

Figure 5

Pre-knotted suture, made by knotting a CV4 GoreTex suture over a nerve hook.