Computer-enhanced mitral valve surgery: toward a total endoscopic procedure.

摘要: The aim of the study was to develop a computer-enhanced, video-assisted approach for mitral valve repair as potential step toward complete endoscopic procedure. In 10 patients with nonischemic insufficiency, computer-enhanced telemetric using Intuitive surgical telemanipulation system performed. A femorofemoral bypass initiated Port-Access (Heartport, Redwood City, CA) cannulation. small minithoracotomy made in right 4th intercostal space, and custom-made rib retractor placed. pericardium opened manually, four traction stay sutures were placed enhance exposure. After endoaortic balloon clamping, left atrium stabilized. end-effectors through two ports (3rd ICS 6th ICS, midaxillary line). 30° three-dimensional (3D)-videoscope angled up incision. Mitral then performed remotely from console. This included inspection valve, leaflet resection, repair, ring implantation. completion testing end effectors withdrawn, closed manually standard instruments (Heartport). all but 1 patient, successful including quadrangular chordal shortening, Whooler-plasty, Alfieri-plasty, could be accomplished system. partial implanted 6 3 patients, respectively. Time surgery, CPB, clamp time 170 330 minutes (median, 185 minutes), 140 220 149 78 133 94 one intraoperative transesophageal echocardiography (TEE) showed insufficient second surgery via an enlarged thoracotomy. One patient recurrent insufficiency had have on postoperative day torn-out ring. Median hospitalization 8 days. At months follow-up (completed 7 patients), improved clinically. Computer-enhanced is feasible can good functional results. offers true repair. However, prolonged, learning curve has overcome.