Case report of robotic instrument–enhanced mitral valve surgery

Abstract

A case of a robot-assisted cardiac operation in the United States is reported. Minimally invasive mitral valve repair was assisted with a surgical robot under a Food and Drug Administration‐guided phase I clinical trial. Clinical summary. A 50-year-old man with severe mitral insufficiency caused by posterior leaflet prolapse underwent minimally invasive mitral valve reconstruction with the use of a robotic telemicromanipulator (ZEUS; Computer Motion Inc, Santa Barbara, Calif). * The patient was placed in a supine position on the operating table with the right arm abducted and flexed above the head. Before the patient was draped, the 3 robotic arms were clamped to the sides of the operating room table. A right anterior 6-cm minithoracotomy ( service entrance incision) was performed in the fourth intercostal space. 1 Standard minimally invasive (port access) technology was used to place the patient on cardiopulmonary bypass and induce cardioplegic arrest 2 . Through the service entrance, the left atrium was opened, and an intra-atrial retractor blade and cardiotomy sucker were positioned. The instruments and endoscope created an inverted triangle, allowing for proper maneuverability of the robotic instruments within the chest cavity without conflict. The left robotic instrument arm was inserted through a 5-mm screw trocar (Karl Storz, GmbH, Tuttiingen, Germany) in the lateral third intercostal space, and the right arm was placed in the medial corner of the service entrance. A 10-mm, 0° endoscope (Karl Storz, GmbH) was then placed in the lateral corner of the service incision. ZEUS instrument setup time was 5 minutes. A prolapsing segment of the posterior leaflet was excised, and the ZEUS Robotic System (ZRS) was used to perform a symmetric folding plasty repair of the valve (Fig 1). 3 Suture knots were thrown extra