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Yoshikawa Y, Kishimoto Y, Onohara T, Horie H, Kumagai K, Nii R, Kishimoto N, Morimoto K, Yoshikawa Y, Nishimura M. Safe launch of a robotically assisted mitral valve repair program in a single center: experience of initial 20 cases under the Center for Minimally Invasive Surgery. J Artif Organs 2023; 26:226-232. [PMID: 35969291 DOI: 10.1007/s10047-022-01348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
Robotically assisted mitral valve repair was approved by the Japanese government in April 2018. However, understanding robotic surgery involves steep learning curves of surgeons and dedicated cardiac teams. The Center for Minimally Invasive Surgery (CMIS) of Tottori University Hospital is a multidisciplinary organization established in 2011 with seven surgical departments. In this study, we report strategies for improving the safety of robotic surgery in the CMIS and early results of robotic mitral valve repair at our hospital. We reviewed the first 20 patients who underwent robotic primary mitral valve repair, including concomitant procedures, from October 2019 to September 2021 under the supervision of the CMIS. Before starting the program, the CMIS requires setting console time limit to 180 min and implementing risk management strategies through simulation training for various mechanical failures. Mitral valve repair was completed in all patients. There was no in-hospital or 30-day mortality. No conversion to median sternotomy was necessary. The analysis of mitral pathology revealed 1 case of functional mitral regurgitation, 12 cases of posterior lesions, 3 cases of anterior lesions, 3 cases of bileaflet lesions, and 1 case of commissural lesion. The average cross-clamp time was 133 ± 27 min. Sixteen cases had trace mitral regurgitation postoperatively, and 4 cases had mild mitral regurgitation. The median (interquartile range) postoperative hospital stay was 10 (8.5-12.5) days. Robotically assisted mitral valve repair was performed safely with assistance from the multidisciplinary CMIS, and the early results were satisfactory without compromising clinical outcomes.
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Affiliation(s)
- Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Nozomi Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kenichi Morimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yuki Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
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Wei S, Zhang X, Cui H, Zhang L, Gong Z, Li L, Ren T, Gao C, Jiang S. Comparison of clinical outcomes between robotic and thoracoscopic mitral valve repair. Cardiovasc Diagn Ther 2020; 10:1167-1174. [PMID: 33224740 DOI: 10.21037/cdt-20-197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background To compare the clinical outcomes and hospital cost of robotic versus thoracoscopic approaches to mitral valve plasty (MVP). Methods We retrospectively analyzed patients who received minimal invasive MVP between 2007 January and 2020 January at our department. The basic characteristics, echocardiography, surgical data, postoperative adverse events and hospital cost of the patients were collected. The primary outcomes of this study were direct hospital cost and 30-day outcomes, including the operative time, complications, and length of hospital stay. Results A total of 234 patients received minimally invasive MVP by using robotic (n=121) and thoracoscopic (n=113) technique respectively. The overall 30-day mortality rate was 0.9% (n=2), with no significant difference between two groups. The cardiopulmonary bypass time and aorta clamping time in thoracoscopic group were longer than that in robotic group (153.2±25.6 vs. 123.8±34.9 min and 111.8±23.0 vs. 84.9±24.3 min, P<0.001). The intraoperative blood transfusion rate (52.2% vs. 64.5%) and ICU time (2.8±2.3 vs. 3.6±2.7 days, all P<0.05) of the thoracoscopic group were lower than those in the robotic group. The adjusted hospital and operating room cost of the thoracoscopic group were significant lower ($18,208.4±$4,429.1 vs. $35,674.3±$4,936.1 and $9,038.3±$2,171.7 vs. $18,655.1±$2,558.3, all P<0.001). Conclusions Both robotic and thoracoscopic approach for MVP are safe and reliable. Robotic technique has shorter operation time, while thoracoscopic technique has more advantages in blood transfusion rate, postoperative ventilation time, ICU duration and hospitalization expenses.
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Affiliation(s)
- Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Zhang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Huimin Cui
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Lin Zhang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhiyun Gong
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Lianggang Li
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Tong Ren
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
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