title: Robotic mitral valve annuloplasty with double-arm nitinol U-clips.
abstract: OBJECTIVE
  Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times.
  
  
  METHODS
  A 67-year-old female was approached through a right mini-thoracotomy with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Using 12 nitinol U-clips (Coalescent Surgical, Sunnyvale, CA) an annuloplasty band was placed under robotic guidance. Clip placement and deployment times were recorded and statistical comparisons were assessed to prior suture annuloplasties.
  
  
  RESULTS
  Clip placement time was 1.3 +/- 0.9 (minutes +/- standard deviation), statistical comparison with first, most recent, and all prior suture annuloplasties proving no significance. Clip deployment time was 0.5 +/- 0.2, whereas knot-tying times and respective statistical comparison for first, most recent, and all prior suture annuloplasties were 2.0 +/- 0.7 (p = 0.003), 1.2 +/- 0.4 (p = 0.0004), and 1.6 +/- 0.6 (p < 0.00001). Follow-up echocardiography performed postoperatively, at 3 months, and at 9 months revealed valvular structural integrity with only minimal mitral regurgitation.
  
  
  CONCLUSIONS
  U-clips considerably reduce time for annuloplasty over conventional suture and may help reduce operative times as well.
authors.affiliation: Division of Cardiothoracic Surgery, The Brody School of Medicine at East Carolina University, Greenville, North Carolina 27858, USA. readec@mail.ecu.edu
authors.forename: Clifton C
authors.initials: CC
authors.lastname: Reade
authors.forename: Curtis E
authors.initials: CE
authors.lastname: Bower
authors.forename: B Marcus
authors.initials: BM
authors.lastname: Bailey
authors.forename: David M
authors.initials: DM
authors.lastname: Maziarz
authors.forename: Saqib
authors.initials: S
authors.lastname: Masroor
authors.forename: Alan P
authors.initials: AP
authors.lastname: Kypson
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors