Robotically assisted mitral valve repair—resectional techniques

Robotic technology enables almost all mitral valve repair techniques in a minimally invasive fashion.Both leaflet resection and chordal replacement are applied in practice to treat flail or prolapsing segments of the posterior leaflet.The multi-wristed robotic end effectors enable comfortable resection maneuvers, which are more challenging with long-shafted minimally invasive cardiac surgery instruments, specifically if advanced techniques such as sliding plasty are necessary.The same applies to suturing the defects after leaflet resection.In this technical video and paper, we describe our robotic mitral valve repair methods.Anesthesia set-up, patient positioning, port placement, cannulation, and mitral valve exposure techniques developed for robotic mitral valve repair are demonstrated and we will focus on resectional techniques for repairing the mitral valve.In most cases, a triangular resection of a prolapsed or flail segment on the posterior leaflet is carried out.Defects after resection are reapproximated using a running suture.Annuloplasty, using a flexible band, completes the repair.The role of the bedside assistant during the repair is critical.In our video, we highlight the synchrony between the bedside assistant and the console surgeon using video footage from both the robot and the assistants' point of view.Finally, we explore patient selection, clinical advantages, surgical challenges, and provide expert operator guidance for avoiding complications.