The String Puppet Technique to Improve Exposure in Totally Endoscopic Mitral Valve Surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Surgical Innovation

Background:

• Traditional atrial retractors can be cumbersome in totally endoscopic cardiac surgery.
• Achieving adequate exposure is crucial for successful mitral and tricuspid valve repair.
• Minimally invasive cardiac surgery requires innovative exposure techniques.

Purpose of the Study:

• To evaluate the feasibility of the string puppet technique.
• To assess its efficacy as an alternative to atrial retractors.
• To determine its safety and ease of use in totally endoscopic valve surgery.

Main Methods:

• A prospective study of 51 patients undergoing totally endoscopic mitral valve repair.
• Utilized a transcutaneous pacing wire as an endoscopic 'sling' for atrial retraction.
• Employed multicolored sutures woven on the sling to manipulate cardiac structures.

Main Results:

• Adequate exposure of mitral and tricuspid valves was achieved in all patients.
• No conversions to sternotomy were required due to insufficient exposure.
• No patients experienced postoperative mitral regurgitation exceeding 1+ after a 2-year follow-up.

Conclusions:

• The string puppet technique is a safe and effective method for improving valve exposure.
• It offers a flexible, dynamic, and cost-efficient alternative to traditional retractors.
• This technique simplifies exposure in totally endoscopic non-robotic mitral and tricuspid valve surgeries.