title: Three-dimensional video and robot-assisted port-access mitral valve operation.
abstract: BACKGROUND
  In order to minimize surgical trauma, video-assisted mitral valve operation has been started using the Port-Access technique with the addition of a three-dimensional visualization system (Vista Cardiothoracic Systems Inc, Westborough, MA) and a voice-controlled camera-holding robotic arm (Aesop; Computer Motion Inc, Goleta, CA).
  
  
  METHODS
  Port-Access mitral valve replacement or repair (PAMVR) was undertaken using an endovascular cardiopulmonary bypass (CPB) system. Fifty patients underwent Port-Access mitral valve replacement or repair. A three-dimensional thoracoscope was inserted allowing complete three-dimensional projection of the mitral valve (Vista). In the last 20 patients, the camera was attached to a robotic arm (Aesop), which allowed stabilization and voice-activated movement of the camera. Mitral valve repair was performed in 26 patients, and the valve was replaced in 24 patients with a mechanical valve prosthesis.
  
  
  RESULTS
  Median time of operation was 4.2 hours, aortic cross-clamp time 83 minutes, CPB time 125 minutes, intensive care unit stay 1.5 days and hospitalization 9.0 days. Three months follow-up was complete in 40 patients, with 34 patients (85%) in New York Heart Association class I and 6 patients in class II. Mortality was 0% and rate of reoperation was 2%, with a follow-up time up to 1.5 years postoperatively.
  
  
  CONCLUSIONS
  Using three-dimensional video and robotic assistance, it was possible to minimize the length of skin incision, but at the same time to optimally visualize the whole mitral valve apparatus in order to perform true Port-Access mitral valve operation, including various repair techniques.
authors.affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians University, Munich, Germany. hcr@hch.med.uni-muenchen.de
authors.forename: H
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: D H
authors.initials: DH
authors.lastname: Boehm
authors.forename: H
authors.initials: H
authors.lastname: Gulbins
authors.forename: C
authors.initials: C
authors.lastname: Schulze
authors.forename: S
authors.initials: S
authors.lastname: Wildhirt
authors.forename: A
authors.initials: A
authors.lastname: Welz
authors.forename: C
authors.initials: C
authors.lastname: Detter
authors.forename: B
authors.initials: B
authors.lastname: Reichart
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012371:Robotics; D013906:Thoracoscopy; D020535:Video-Assisted Surgery