The incisions that we use for mitral valve repair are very small. We do no spread the ribs which reduces pain. The cosmetic results are hard to match with any other technique. Most importantly, we do the same operation that a typical surgeon does with larger, more painful incisions. We place a huge emphasis on not compromising quality of the operation just to make a small incision. As you can see from the adjacent figures detailing the scars from a robotic mitral valve repair, this is truly a minimally invasive approach. For mitral repair, the largest chest incision is 15 mm and for replacement 35 mm. For mitral valve surgeries, we also usually make a small incision over the artery and vein to the leg. In select cases, we can use a totally percutaneous (no incision just puncture) approach.

Typical incisions for a totally endoscopic robotic mitral valve repair. The procedure can be done in large or small patients.
Typical incisions for a totally endoscopic robotic mitral valve repair.

Patients who are large may actually benefit the most although the technique is used in almost all body types. Patients with previous surgery may benefit from our approach by avoiding previous scar tissue from the previous surgery. Patients who have had prior surgery on the right chest may not be able to be done (some can) this way due to excessive scar tissue. Extensive evaluation and planning occurs prior to surgery, most notably with a 3D CT scan of the body from the chest down to the upper legs.

Patients and their referring physicians should know that under the term “minimally invasive” or “robotic” there are a wide variety of incision sizes performed in the country. A 8-10 cm right chest incision (thoracotomy) with rib spreading is not very minimally invasive. At the opposite end of the spectrum, for mitral repair we use 4 pencil size incisions (8mm) and 1 thumb sized incision (15mm) just in front of the right arm pit. There is no rib spreading and no portion of the operation can be done by looking through these incisions, hence the term “endoscopic” because we use a robotic endoscope to visualize everything and robotic instruments to perform the procedure while looking through the camera.

Category: Questions about Robotic Cardiac Surgery Procedures
T. Sloane Guy, MD

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