Video-assisted and robotic mitral valve surgery: toward an endoscopic surgery

Our group at East Carolina University recently has shown the efficacy of new video-assisted mitral valve surgery. Moreover, we review the evolution and predict the future of endoscopic and robotic-enabling technology for cardiac valve surgery. Herein, a video-assisted mitral valve operation is described and early results are discussed. Cardiopulmonary bypass was established via the femoral vessels, and blood cardioplegic arrest was induced by using a new percutaneous, transthoracic cross-clamp. A 6-cm minithoracotomy was used in each patient. Videoscopy was helpful for suture placement, chord reconstruction, leaflet resection, knot tying, and valve ring or prosthesis positioning. Thus far, 85 patients have undergone this surgery successfully with a 1.2% surgical mortality rate. Our early study with cost data is reviewed in detail. Cardiopulmonary perfusion times and cross-clamp periods for the entire group have been longer than for conventional sternotomy patients at 167 +/- 4.6 minutes and 120 +/- 4.0 minutes, respectively, but complications have been less. Complex repairs and replacements were possible. Bleeding, ventilatory times, and hospital lengths of stay have been reduced. One patient required a second surgery for a failed repair. Recently, we have used voice-activated, robotic assistance for camera control in 28 patients. This has decreased camera motion artifact and lens cleaning while providing direct cerebral-eye tracking of instruments by the surgeon. From this and other studies we reviewed, we conclude that video-assisted and computer-assisted robotic techniques are safe and may be the pathway to truly endoscopic mitral valve surgery.