Minimally Invasive Mitral Valve Repair

A team of surgeons has been able to successfully make mitral valve repairs through a small 5 cm incision with the help of a computer-enhanced robotic device. The team, from East Carolina University's Brody School of Medicine (Greenville, USA), is conducting the first clinical trial of minimally invasive mitral valve surgery with a robotic device. They report that the device enables them to complete complex valve repairs that would not be possible otherwise.

In the procedure, the team inserts a small camera through the incision in order to track their movements on a monitor as they manipulate longer-than-usual surgical instruments. The robotic system they are using is based on technology developed by the U.S. Department of Defense. The system consists of three arms. One arm holds a camera equipped with a 3-D videoscope, and the other two hold robotic instruments that have articulating tips that operate needle holders, microscissors, and tissue graspers.

With their first eight patients, the team found that the new procedure reduced the need for postoperative monitoring in the intensive care unit (ICU). Because the surgery is less invasive and does not involve cutting the breastbone or making a large incision, patients do not experience the intense inflammatory reaction caused by bleeding from the sternum and they experience less pain, say the surgeons. In addition, patients stay in the hospital about eight days following conventional surgery. With the new procedure, they may go home in three days. Few require a blood transfusion, and hospital costs are reduced about 33%.

"With the robot, you can drive a tiny camera into the left ventricle of the heart and see and repair the subvalvular apparatus, which includes all the muscles and cords that hold the valve and the valve leaflets in place,” said L. Wiley Nifong, M.D., assistant professor of cardiovascular surgery at Brody.