title: Robotically controlled video-assisted port-access mitral valve surgery.
abstract: From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 +/- 1.2 hours, aortic crossclamp time was 58 +/- 16 minutes, intensive care unit stay was 22 +/- 7 hours, and hospital stay was 6.4 +/- 1.2 days. Median postoperative blood loss was 332 +/- 104 mL. There was 1 hospital death. On follow-up at 16.4 +/- 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 +/- 0.5 to 1.4 +/- 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.
authors.affiliation: Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
authors.forename: Yugal K
authors.initials: YK
authors.lastname: Mishra
authors.forename: Mitesh
authors.initials: M
authors.lastname: Sharma
authors.forename: Surinder
authors.initials: S
authors.lastname: Bazaz
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.forename: Krishan Kant
authors.initials: KK
authors.lastname: Sharma
authors.forename: Sameer
authors.initials: S
authors.lastname: Shrivastava
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D012371:Robotics; D020535:Video-Assisted Surgery / Q000379:methods*