Totally Endoscopic Robotic Mitral Valve Surgery

A New Frontier: No Working Port for Robotic Mitral Valve Repair

A 61-year-old male presented via referral for mitral regurgitation and was deemed an appropriate robotic surgery candidate for complex mitral valve repair with the maze procedure and patent foramen ovale and left atrial appendage closures, using all percutaneous cannulation. We report upon the first case in the literature that describes the use of only 4 robotic ports, with no working port used.

Totally endoscopic mitral valve repair without robotic assistance: A case report

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Robotic TEMVR is the most advanced level of MICS.

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We have performed TEMVR using no robotic system.

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The used equipment included MICS instruments and a 3D Endoscopic system.

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We improved mitral valve exposure techniques and surgical port placement.

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We used sutures as a left atrial retractor to expose mitral valve.

Introduction

Totally endoscopic mitral valve repair (TEMVR) is the highest level of minimally invasive cardiac surgery (MICS). It brings many benefits to patients but the downside is that a robotic system is always required. The deployment of robotic surgery is very complicated and expensive. Therefore, we improvised, making it possible to perform TEMVR without the aid of a robotic system.

Presentation of case

A 66-year-old male patient presented with severe mitral valve regurgitation due to posterior leaflet prolapse. He was treated with TEMVR without robotic assistance. No chest incision was over 1.2 cm. The repair techniques included posterior leaflet resection and annuloplasty with ring implantation.

Discussion

A midline sternotomy is still the standard approach for mitral valve repair. In recent years, MICS has gradually replaced conventional surgery with the most advanced strategy being totally robotic mitral valve repair. However, complex surgical techniques and high cost make it less accessible for the majority of patients. Instead of using robot, we improved mitral valve exposure techniques, surgical port placement and therefore were able to perform TEMVR with MICS instruments.

Conclusion

TEMVR without robotic assistance is a safe, effective and cost-efficient procedure, which can be adopted in most cardiac centers.

Risk of adhesive bowel obstruction after abdominal surgery. A national cohort study of 665,423 Danish women

BACKGROUND

Adhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated.

METHOD

In a national cohort of all Danish women with an abdominal operation (N = 665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year.

RESULTS

In the cohort, 1.4% experienced an episode of adhesive bowel obstruction. The risk increased 33-43% during the study period, was lower after gynecological and obstetrical procedures compared to gastrointestinal (HR 0.36 [0.34-0.38]), lower after laparoscopic compared to laparotomic surgery (HR 0.51 [0.48-0.54]) and increased proportionally after each additional operation.

CONCLUSIONS

The risk of adhesive bowel obstruction after abdominal operations depends on the site of earlier operations, the method of access and the number of earlier operations.