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Updated: Apr 23, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Robotically assisted, completely endoscopic transmyocardial revascularization is feasible
Louis A Brunsting1, Averel B Snyder, Eric A Espinal
1From the *Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL USA; †St. Joseph's Hospital, Atlanta, GA USA; ‡Akron City Hospital, Akron, OH USA; and §The International Centre for Robotic Surgery, New Delhi, India.
Robotically assisted transmyocardial revascularization (TMR) using an endoscopic laser delivery system (LDS) is feasible. This minimally invasive approach demonstrated high success rates and significant angina relief with minimal early adverse events.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Medical Device Technology
Background:
- Transmyocardial revascularization (TMR) is a treatment for refractory angina.
- Traditional TMR can be invasive.
- Advancements in endoscopic and robotic technology offer potential for less invasive surgical options.
Purpose of the Study:
- To evaluate the feasibility of a novel endoscopic, optical-fiber-based laser delivery system (LDS).
- To assess the efficacy of sole-therapy TMR performed robotically and endoscopically.
- To determine procedural success and early clinical outcomes of this approach.
Main Methods:
- A multicenter, prospective, single-arm clinical trial involving 42 patients.
- Transmyocardial revascularization (TMR) performed entirely endoscopically with robotic assistance.
- Utilized a Holmium:YAG laser delivery system (LDS) introduced via a 5-mm port.
Main Results:
- High procedural success rate of 93% (39/42 patients).
- No operative or 30-day mortality; 95% freedom from major adverse cardiac events at 30 days.
- Significant reduction in Canadian Cardiovascular Score angina class (P < 0.001) at 6-month follow-up.
Conclusions:
- Robotically assisted TMR using an endoscopic LDS is a feasible procedure.
- The technique achieves high procedural success and avoids early adverse events.
- This approach shows potential for effective angina relief in patients with refractory angina.
