Early experience in human-controlled robotic-like cardiovascular surgery utilizing ARTISENTIAL^® articulated...

Robot-assisted minimally invasive cardiac surgery (MICS) offers high precision but remains costly and technically demanding, posing challenges for surgeons accustomed to median sternotomy. We aimed to explore a transitional approach toward robotic-like, human-controlled minimally invasive cardiovascular surgery (MICVS) using ARTISENTIAL^® articulated instruments, which provide mechanically transmitted tactile sensation.

From 2023 to 2025, 10 patients underwent cardiovascular procedures in which ARTISENTIAL^® was employed as an adjunctive tool for selected procedural components, including atriotomy closure, mitral and tricuspid annuloplasty, ventricular tumor resection, and graft anastomosis. ARTISENTIAL^® was used via median sternotomy in nine cases, in which custom-designed "Gride-Spin Holders" were developed to secure the instruments to the retractor bar, and through a totally endoscopic approach in one case.

All ARTISENTIAL^®-assisted procedural components were completed without intraoperative complications. The articulated motion and mechanically transmitted tactile sensation allowed surgeons to manipulate the needle with a subjective perception of tissue resistance during suturing. The custom-designed Gride-Spin Holders functioned effectively, providing stable instrument positioning and smooth maneuverability throughout the procedures.

This approach appears feasible for selected procedural components and may serve as a practical transitional strategy toward minimally invasive cardiac surgery, requiring less infrastructural investment than fully robotic platforms and allowing a stepwise transition toward MICVS.