title: Robotic mitral valve repair: experience with the da Vinci system.
abstract: BACKGROUND
  As part of a Food and Drug Administration trial, mitral repairs were performed in 38 patients using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Mountain View, CA). Prospectively, we evaluated safety and efficacy in performing both simple and complex mitral repairs.
  
  
  METHODS
  Eligible patients had nonischemic moderate to severe mitral insufficiency. Operative techniques included peripheral cardiopulmonary perfusion, a 4- to 5-cm mini-thoracotomy, transthoracic aortic occlusion, and antegrade blood cardioplegia. Transesophageal echocardiograms were done intraoperatively with three-dimensional reconstructions. Successful repairs were defined as mild or less residual regurgitation.
  
  
  RESULTS
  Enhanced three-dimensional visualization of mitral leaflets and the subvalvar apparatus allowed safe, dexterous intracardiac tissue manipulation. All patients had successful valve repairs including quadrangular resections, sliding plasties, and edge-to-edge approximations, as well as both chordal transfers and replacements. There were no operative deaths, strokes, or device-related complications. One patient required valve replacement for hemolysis and 1 was reexplored for bleeding. There were no incisional conversions. Both robotic repair and total operating times decreased significantly from 1.9 +/- 0.1 and 5.1 +/- 0.1 hours (mean +/- standard error of the mean) for the first 19 patients to 1.5 +/- 0.1 (p = 0.002) and 4.4 +/- 0.1 hours (p = 0.04) for the last 19 operations, respectively. Total hospital length of stay for patients was 3.8 +/- 0.6 days. Of all patients, 31 (82%) had a 4-day or less length of stay. Seven patients (18%) had stays between 5 and 9 days (6.4 +/- 1.0).
  
  
  CONCLUSIONS
  This study shows that the da Vinci surgical system (Intuitive Surgical, Inc) has few limitations in performing complex valve repairs. Articulated wrist-like instruments and three-dimensional visualization enabled precise tissue telemanipulation. Future robotic design advances and adjunctive suture technologies may promote continuing evolution of robotic cardiac operations.
authors.affiliation: Department of Surgery and the Center for Minimally Invasive and Robotic Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina 27858, USA.
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: Victor F
authors.initials: VF
authors.lastname: Chu
authors.forename: B Marcus
authors.initials: BM
authors.lastname: Bailey
authors.forename: David M
authors.initials: DM
authors.lastname: Maziarz
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Sorrell
authors.forename: Donald
authors.initials: D
authors.lastname: Holbert
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D007902:Length of Stay; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D013536:Suture Techniques