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Robotic Surgery for Repair of the Mitral Valve

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By Lisa Wilson | Image by Kjpargeter/Shutterstock.com |

Robotic surgery for repair of the mitral valve has become a standard procedure in the fair of cardiology. What is the Mitral valve:-“A valve in the heart that is situated between the left atrium (LA) and the left ventricle (LV). The mitral valve permits blood to flow from the left atrium into the left ventricle, but not in the reverse direction.”(http://www.medicinenet.com/script/main/art.asp?articlekey=4410) Robotic mitral valve repair is a central method in the current treatment of mitral regurgitation. Prior to the late 90’s this would have been a rare procedure.  In 1998 mitral valve repair surgery was done with a primitive form of the “DaVinci” robot.  Since that time this procedure has become more common place. “The first robotic mitral repair in North America was performed by Chitwood in 2000” (http://www.annalscts.com/article/view/2896/3812)

During the procedure the surgeon actually sits at a control panel manipulating microscopic surgical instruments.  The surgeon has undergone great training to complete this procedure.  The surgeon is able to visualize the surgical site with cameras and magnification. Robotic surgery allows for minute movements that the human hand and nervous system are not capable of. As time goes on developments in this field improve success rates, and expand the variety of cases that can be done in this manner.

Benefits of robotic mitral valve surgery are often related to the precision of the robotic procedure.  In a similar fashion many years ago people were mystified by the concept of laparoscopic surgery. This surgery was done with small puncture holes and assisted by cameras.  The benefits of this meant much smaller wounds, decreased hospital stay, and a shorter recovery time.  Robotic mitral valve surgery is also minimally invasive, especially in the world of cardiac surgery, smaller incisions, less risk of error.  This also minimizes slightly the traumatic effect of the surgery on the patient.

Robotic mitral valve surgery shows results that are similar to open procedures going through the sternum.   The mortality rates are significantly lower though. Another noted benefit is a decreased overall hospital stay and a reduced incidence of unwanted side effects/complications.  Some of these include new onset atrial fibrillation secondary to the procedure and pulmonary effusion.  (http://www.annalscts.com/article/view/2896/3812)

Disadvantages:  lack of tactile feedback for surgeons.  Also very risky to use with high risk patients.  This includes patients with significant respiratory problems. Patients with these conditions may be better served by the traditional sternotomy approach.

With advances in current technology instruments are becoming more compact and precise.  This makes robotic surgery a great tool in the advancement of medical technology. This will decrease mortality rates in patients that are candidates for robotic mitral valve repair.  Future advances in the field of robotic surgery will open the door for other surgical interventions that can save lives and reduce risk of complications and infections.

References:

  1. Bush B, Nifong LW, Alwair H, Chitwood WR. Robotic mitral valve surgery—current status and future directions. Ann Cardiothorac Surg. 2013; 2(6): 814–817
  2. Elizabeth G. Robotic mitral valve repair. J Cardiovasc Nurs. 2015;30(4):325-31
  3. Definition of Mitral valve. medicinenetcom. 2016. Available at: http://www.medicinenet.com/script/main/art.asp?articlekey=4410

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