Learning curve analysis of mitral valve repair using telemanipulative technology.

Objective: To determine if the time required to perform mitral valve repairs using telemanipulation technology decreases with experience and how that decrease is influenced by patient and procedure variables.

Methods: A single-center retrospective review was conducted using perioperative and outcomes data collected contemporaneously on 458 mitral valve repair surgeries using telemanipulative technology. A regression model was constructed to assess learning with this technology and predict total robot time using multiple predictive variables.

Significant reduction in annuloplasty operative time with the use of nitinol clips in robotically assisted mitral valve repair.

Objective: A substantial barrier to widespread adoption of robotically assisted mitral valve repair surgery is increased operative time compared with that of median sternotomy. Nitinol U-clips (Medtronic, Minneapolis, Minn) made of a shape-memory alloy eliminate intrathoracic suturing and may reduce operative times.

Methods: A retrospective review of robotically assisted mitral valve repair surgery was done at East Carolina University, where preoperative, intraoperative, and postoperative data were collected prospectively.

Acute effects of suction retraction on atrial hemodynamics and histology.

Objectives: In minimally invasive and robotic mitral valve surgery, a blade retractor is used to elevate the left atrial roof, which often distorts tissue and impairs visualization. We tested the hemodynamic and histologic changes of intra-atrial suction, using a new suction retractor that may improve stabilization and visualization.

Methods: Swine were divided into 3 equal (n = 4) groups: blade retractor, suction retractor, and arrested heart control.

Robotic skeletonizing of the internal thoracic artery: is it safe?

Background: The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA).