Robotic-assisted instruments enhance minimally invasive mitral valve surgery

Background. The potential for totally endoscopic mitral valve surgery has b een advanced by the development of minimally invasive techniques. Recently surgical robots have offered instrument access through small ports, obviati ng the need for a significant thoracotomy. This study tested the hypothesis that a microsurgical robot with 5 degrees of freedom is capable of perform ing an endoscopic mitral valve replacement (MVR). Methods. Dogs (n = 6) were placed on peripheral cardiopulmonary bypass; aor tic occlusion was achieved with endoaortic clamping and transesophageal ech ocardiographic control. A small left seventh interspace "service entrance" incision was used to insert sutures, retractor blade, and valve prosthesis. Robotically controlled instruments included a thoracoscope and 5-mm needle holders. MVR was performed using an interrupted suture technique. Results. Excellent visualization was achieved with the thoracoscope. Instru ment setup required 25.8 minutes (range 12 to 37); valve replacement requir ed 69.3 +/- 5.39 minutes (range 48 to 78). MVR was accomplished with normal prosthetic valve function and without misplaced sutures or inadvertent inj uries. Conclusions. This study demonstrates the feasibility of adjunctive use of r obotic instrumentation for minimally invasive MVR. Clinical trials are indi cated. (Ann Thorac Surg 2000;70:835-8) (C) 2000 by The Society of Thoracic Surgeons.