The Leipzig experience with robotic valve surgery

Objectives: The study describes the single-center experience using robot-as sisted videoscopic mitral valve surgery and the early results with a remote telemanipulator-assisted approach for mitral valve repair. Material and Me thods: Out of a series of 230 patients who underwent minimally invasive mit ral valve surgery, in 167 patients surgery was performed with the use of ro botic assistance. A voice-controlled robotic arm was used for videoscopic g uidance in 152 cases. Most recently, a computer-enhanced telemanipulator wa s used in 15 patients to perform the operation remotely. Results: The mitra l valve was repaired in 117 and replaced in all other patients. The voice-c ontrolled robotic arm (AESOP 3000) facilitated videoscopic-assisted mitral valve surgery. The procedure was completed without the need for an addition al assistant as "solo surgery." Additional procedures like radiofrequency a blation and tricuspid valve repair were performed in 21 and 4 patients, res pectively. Duration of bypass and clamp time was comparable to conventional procedures (107 Angstrom 34 and 50 Angstrom 16 min, respectively). Hospita l mortality was 1.2%. Using the da Vinci telemanipulation system, remote mi tral valve repair was successfully performed in 13 of 15 patients. Conclusi on: Robotic-assisted less invasive mitral valve surgery has evolved to a re liable technique with reproducible results for primary operations and for r eoperations. Robotic assistance has enabled a solo surgery approach. The co mbination with radiofrequency ablation (Mini Maze) in patients with chronic atrial fibrillation has proven to be beneficial. The use of telemanipulati on systems for remote mitral valve surgery is promising, but a number of pr oblems have to be solved before the introduction of a closed chest mitral v alve procedure.