title: Totally endoscopic mitral valve repair using a robotic-controlled atrial retractor.
abstract: OBJECTIVE
  Our aim was to assess the feasibility of totally endoscopic robotic mitral valve surgery using a novel atrial retractor manipulated by a fourth arm da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA).
  
  
  METHODS
  Eighteen patients with mitral valve disease underwent totally endoscopic mitral valve surgery using the retractor. It was inserted in the second or third intercostal space just lateral to the sternum, and it was manipulated at the robotic console for dynamic exposure of the valve structures.
  
  
  RESULTS
  Mitral valve repair procedures were feasible in all patients with the robotic-controlled atrial retractor providing superior exposure of the mitral valve anatomy. The time until satisfactory exposure of the mitral valve was noticeably decreased with the robotic retractor. All patients were discharged home in sinus rhythm and transesophageal echocardiography revealed competent mitral valves.
  
  
  CONCLUSIONS
  The EndoWrist atrial retractor (Intuitive Surgical Inc) facilitated complex totally endoscopic mitral valve surgery, including concomitant procedures, regardless of pathology with excellent clinical outcomes.
authors.affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA. amy_engel@trihealth.com
authors.forename: J Michael
authors.initials: JM
authors.lastname: Smith
authors.forename: Hubert
authors.initials: H
authors.lastname: Stein
authors.forename: Amy M
authors.initials: AM
authors.lastname: Engel
authors.forename: Sarah
authors.initials: S
authors.lastname: McDonough
authors.forename: Lindsey
authors.initials: L
authors.lastname: Lonneman
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome