Endoscopic Robotic Mitral Operating Room as a Microsystem for Safety and Sustainability.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic mitral valve (MV) surgery requires a focus on safety and sustainability.
• Challenges include surgeon positioning, patient complexity, and administrative support.
• A systems approach is crucial for maximizing patient safety and service viability.

Purpose of the Study:

• To evaluate the safety and efficacy of a dedicated robotic operating room (OR) microsystem for mitral valve procedures.
• To assess the impact of this approach on patient outcomes, including morbidity and mortality.

Main Methods:

• A single dedicated robotic OR was organized as a microsystem with specialized team training.
• Training encompassed operative steps, ergonomics, digital tools, and a safety culture.
• Retrospective review of outcomes for all robotic mitral procedures performed by a single surgeon.

Main Results:

• 1,529 consecutive patients underwent robotic MV surgery between 2014-2023.
• Conversion to conventional approach occurred in 0.65% of cases.
• High rates of successful repair (85%) with excellent regurgitation control (92.7% none to trace).
• Low mortality (0.08% repair, 0.87% replacement) and stroke rates (0.31% repair, 1.3% replacement).

Conclusions:

• Organizing a robotic OR as a microsystem is linked to surgical efficacy and minimal morbidity/mortality.
• This microsystem approach can enhance safety and sustainability for robotic MV programs.
• Components of this model may be adaptable to various levels of robotic MV program development.