Robotic mitral valve operations can be safely performed in obese patients

The Role of Robotics in Cardiac Surgery: Innovations, Outcomes, and Future Prospects

In recent years, there has been a notable increase in the use of robotic technology in medical surgery, especially in heart surgery. Many advancements in surgery have been made possible by the development of these robotic devices, such as the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, United States). These advancements include improved ergonomics, three-dimensional (3D) imaging, and increased dexterity. This research evaluates the advancements, results, and potential applications of robots in heart surgery. A systematic review that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles was carried out. The PubMed and Cochrane databases underwent a thorough search that turned up articles from 2015 to 2023. Nine articles that satisfied the requirements for inclusion were evaluated for quality using the Critical Appraisal Skills Programme (CASP) checklists. Standardized templates and conventional content analysis techniques were used for data extraction and analysis, respectively. Nine studies with a range of approaches, including randomized, prospective, observational, and retrospective investigations, were included in the review. This research included a variety of robotic heart treatments, including mitral valve repair, atrial septal defect (ASD) closure, and coronary artery bypass grafting (CABG). Notable results include identical or shorter operating durations, fatality rates that are comparable to those of conventional techniques, fewer postoperative complications, and shorter hospital stays. Surgeons did, however, face an initial learning curve. Variants of the da Vinci surgical system were the most frequently used robotic systems. Robotic heart surgery has shown encouraging outcomes in terms of effectiveness, safety, and patient recovery. The dependability of robotic procedures is demonstrated by shorter operating times, reduced blood loss, a low incidence of conversion to conventional methods, and a reduction in postoperative complications. Shorter hospital stays suggest better patient outcomes and potential financial advantages. Nonetheless, the need for specific training and knowledge among surgeons is emphasized. Sustained investigation and advancement are essential for the refinement and broader use of robotic heart surgery. Robotic-assisted cardiac surgery has a promising future with a focus on improved patient outcomes, training, and procedural development.

Subvalvular techniques enhanced with endoscopic robotic mitral valve repair

Objective

Totally endoscopic intracardiac robotic surgery is generally limited to uncomplicated mitral valve surgery. With experience, our team has developed a more aggressive approach to robotic cardiac surgery that allows for repair of a broad spectrum of mitral valve pathologies. We report complex subvalvular procedural advancements associated with this approach secondary to enhanced team experience and capabilities.

Methods

All robotic mitral procedures performed by a 2-surgeon team in a quaternary care medical center from July 2011 to May 2022 were reviewed. Natural language-processing techniques were used to analyze operative reports for subvalvular repair techniques. Complex subvalvular techniques included papillary muscle repositioning, division of secondary anterior leaflet chordae, septal myomectomy, division of aberrant left ventricular muscle band attachments, and left ventricular patch reconstruction. The surgical experience was divided into 2 periods: early robotic experience (pre-2018) versus late (2018 onwards). Baseline demographics, outcomes, and subvalvular techniques were analyzed and compared.

Results

A total of 1287 intracardiac robotic operations were performed by a 2-surgeon team. Thirty-day mortality was 0.6% (8/1287). Mitral valve repair was performed in 1024 patients. The mean age was 61 years (range, 18-90 years), and 15% were >75 years old; 29 patients (2.8%) had previously undergone cardiac surgery. There was a significant increase with experience in the application of advanced subvalvular techniques between the early versus late period (52.3% [268/512] vs 74.2% [380/512] (P < .001)).

Conclusions

An experienced 2-surgeon team can perform progressively more complex robotic subvalvular repair techniques. These subvalvular techniques are a surrogate for team proficiency and capabilities.

A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair

OBJECTIVE

Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy.

METHODS

A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible.

RESULTS

The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches.

CONCLUSIONS

Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.