Minimally Invasive and Robotic Cardiac Surgery

  • Loris Salvador


In this chapter the discussion will be confined to the ministernotomy approach, the thoracoscopic video-assisted or video-guided surgery (port access), and robot-assisted surgery. The growing evidence of interest and the increasing number of published articles are reflecting the attention that cardiac surgeons pay to this subject. Port access and robotic surgery are stimulating techniques that require a new attitude for surgeons: different incision (minithoracotomy and ports), different view (screens and monitors and 3D vision), different surgeon location (sitting a few meters from the patient on the robotic platform).


Mitral Valve Robotic Surgery Mitral Valve Repair Port Access Vinci System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H (2003) Mitral valve surgery can now routinely be performed endoscopically. Circulation 108(Suppl 1):II48–II54PubMedGoogle Scholar
  2. 2.
    Rosengart TK, Feldman T, Borger MA, Vassiliades TA, Gillinov AM, Hoercher KJ, Vahanian A, Bonow RO, O’Neill W (2008) Percutaneous and minimally invasive valve procedures. A scientific statement from the american heart association council on cardiovascular surgery and anesthesia, council on clinical cardiology, functional genomics and translational biology interdisciplinary working group, and quality of care and outcomes research interdisciplinary working group. Circulation 117:1750–1767Google Scholar
  3. 3.
    Litynski GS (1997) Raoul palmer, world war II, and transabdominal coelioscopy. Laparoscopy extends into gynecology. JSLS 1(3):289–292PubMedCentralPubMedGoogle Scholar
  4. 4.
    Morgenstern L (2005) Against the tide: kurt karl stephan semm (1927–2003). Surg Innov 12(1):5–6PubMedCrossRefGoogle Scholar
  5. 5.
    Reynolds Walker Jr (2001) The first laparoscopic cholecystectomy. JSLS 5(1):89–94PubMedCentralPubMedGoogle Scholar
  6. 6.
    Kirby TJ, Rice TW (1993) Thoracoscopic lobectomy. Ann Thorac Surg 56:784–786PubMedCrossRefGoogle Scholar
  7. 7.
    Lewis RJ (1993) The role of video-assisted thoracic surgery for cancer of the lung: wedge resection to lobectomy by simultaneous stapling. Ann Thorac Surg 56:762–768PubMedCrossRefGoogle Scholar
  8. 8.
    Burke RP, Chang AC (1993) Video-assisted thoracoscopic division of a vascular ring in an infant. J Card Surg 8:537–540PubMedCrossRefGoogle Scholar
  9. 9.
    Furuse A, Kohno T, Ohtsuka T (1995) Intraoperative visualization of the aortic valve from the left ventricle. J Thorac Cardiovasc Surg 109:395PubMedCrossRefGoogle Scholar
  10. 10.
    Kaneko Y, Kohno T, Ohtsuka T, Ohbuchi T, Furuse A, Konishi T (1996) Video-assisted observation in mitral valve surgery. J Thorac Cardiovasc Surg 111:279–280PubMedCrossRefGoogle Scholar
  11. 11.
    Peters WS (1993) Minimally invasive cardiac surgery by cardioscopy. Aust J Cardiac Thorac Surg 2:152–154CrossRefGoogle Scholar
  12. 12.
    Pompili MF, Yakub A, Siegel LC, Stevens JH, Awang Y, Burdon TA (1996) Port-access mitral valve replacement: initial clinical experience. Circulation 94(Suppl 1):533Google Scholar
  13. 13.
    Carpentier A, Loulmet D, Carpentier A, Le Bret E, Haugades B, Dassier P, Guibourt P (1996) Open heart operation under videosurgery and minithoracotomy: first case (mitral valvuloplasty) operated with success. C R Acad Sci III 319:219–223PubMedGoogle Scholar
  14. 14.
    Carpentier A, Loulmet D, Aupècle B et al (1998) Computer assisted open heart surgery. First case operated on with success. C R Acad Sci III 321:437–442PubMedCrossRefGoogle Scholar
  15. 15.
    Cosgrove DM, Sabik JF (1996) Minimally invasive approach for aortic operations. Ann Thorac Surg 62:596–597PubMedCrossRefGoogle Scholar
  16. 16.
    Navia JL, Cosgrove DM (1996) Minimally invasive mitral valve operations. Ann Thorac Surg 62:1542–1544PubMedCrossRefGoogle Scholar
  17. 17.
    Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, Aranki SF (1997) Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 4:421–428CrossRefGoogle Scholar
  18. 18.
    Holzhey DM, Shi W, Borger MA, Seeburger J, Garbade J, Pfannmüller B, Mohr FW (2011) Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison. Ann Thorac Surg 91(2):401–405PubMedCrossRefGoogle Scholar
  19. 19.
    Santana O, Reyna J, Grana R, Buendia M, Lamas GA, Lamelas J (2011) Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg 91(2):406–410PubMedCrossRefGoogle Scholar
  20. 20.
    McCreath BJ, Swaminathan M, Booth JV, Phillips-Bute B, Chew STH, Glower DD, Stafford-Smith M (2009) Mitral valve surgery and acute renal injury: port access versus median sternotomy. Ann Thorac Surg 75:812–819CrossRefGoogle Scholar
  21. 21.
    Loulmet D, Carpentier A, Cho PW, Berrebi A, d’Attellis N, Austin CB, Couëtil JP, Lajos P (1998) Less invasive techniques for mitral valve surgery. J Thorac Cardiovasc Surg 115:772–779PubMedCrossRefGoogle Scholar
  22. 22.
    Aris A (1999) Reversed ‘C’ ministernotomy for aortic valve replacement. Ann Thorac Surg 67:1806–1807PubMedCrossRefGoogle Scholar
  23. 23.
    Chang YS, Lin PJ, Chang CH, Chu JJ, Tan PP (1999) ‘I’ ministernotomy for aortic valve replacement. Ann Thorac Surg 68:40–45PubMedCrossRefGoogle Scholar
  24. 24.
    Svensson LG (1997) Minimal-access ‘J’ or ‘j’ sternotomy for valvular, aortic, and coronary operations or reoperations. Ann Thorac Surg 64:1501–1503PubMedCrossRefGoogle Scholar
  25. 25.
    Tabata M, Umakanthan R, Cohn LH, Bolman RM 3rd, Shekar PS, Chen FY, Couper GS, Aranki SF (2008) Early and late outcomes of 1000 minimally invasive aortic valve operations. Eur J Cardiothorac Surg 33(4):537–541PubMedCrossRefGoogle Scholar
  26. 26.
    Autschbach R, Walther T, Falk V, Diegeler A, Metz S, Mohr FW (1998) S-shaped in comparison to L-shaped partial sternotomy for less invasive aortic valve replacement. Eur J Cardiothorac Surg 14(Suppl 1):S117–S121 453PubMedCrossRefGoogle Scholar
  27. 27.
    Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL (1998) Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 65(4):1100–1104PubMedCrossRefGoogle Scholar
  28. 28.
    Nair RU, Sharpe DA (1998) Minimally invasive reversed Z sternotomy for aortic valve replacement. Ann Thorac Surg 65:1165–1166PubMedCrossRefGoogle Scholar
  29. 29.
    Kasegawa H, Shimokawa T, Matsushita Y, Kamata S, Ida T, Kawase M (1998) Right-sided partial sternotomy for minimally invasive valve operation: ‘open door method’. Ann Thorac Surg 65:569–570PubMedCrossRefGoogle Scholar
  30. 30.
    Suri RM, Schaff HV, Meyer SR, Hargrove WC III (2009) Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes. Ann Thorac Surg 88:1185–1190PubMedCrossRefGoogle Scholar
  31. 31.
    Raanani E, Spiegelstein D, Sternik L, Preisman S, Moshkovitz Y, Smolinsky AK, Shinfeld A (2010) Quality of mitral valve repair: median sternotomy versus port-access approach. J Thorac Cardiovasc Surg 140(1):86–90PubMedCrossRefGoogle Scholar
  32. 32.
    Iribarne A, Russo MJ, Easterwood R, Hong KN, Yang J, Cheema FH, Smith CR, Argenziano M (2010) Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis. Ann Thorac Surg 90(5):1471–1478PubMedCrossRefGoogle Scholar
  33. 33.
    Richardson L, Richardson M, Hunter S (2008) Is a port-access mitral valve repair superior to the sternotomy approach in accelerating postoperative recovery? Interact Cardiovasc Thorac Surg 7(4):678–683PubMedCrossRefGoogle Scholar
  34. 34.
    Galloway AC, Schwartz CF, Ribakove GH, Crooke GA, Gogoladze G, Ursomanno P, Mirabella M, Culliford AT, Grossi EA (2009) A decade of minimally invasive mitral repair: long-term outcomes. Ann Thorac Surg 88(4):1180–1184PubMedCrossRefGoogle Scholar
  35. 35.
    Seeburger J, Borger MA, Doll N, Walther T, Passage J, Falk V, Mohr FW (2009) Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg 36:532–553PubMedCrossRefGoogle Scholar
  36. 36.
    Glower DD, Siegel LC, Frischmeyer KJ, Galloway AC, Ribakove GH, Grossi EA, Robinson NB, Ryan WH, Colvin SB (2000) Predictors of outcome in a multicenter port-access valve registry. Ann Thorac Surg 70(3):1054–1059PubMedCrossRefGoogle Scholar
  37. 37.
    Modi P, Hassan A, Chitwood WR Jr (2009) Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 34(5):943–952CrossRefGoogle Scholar
  38. 38.
    Ricci D, Pellegrini C, Aiello M, Alloni A, Cattadori B, D’Armini AM, Rinaldi M, Viganò M (2010) Port-access surgery as elective approach for mitral valve operation in re-do procedures. Eur J Cardiothorac Surg 37(4):920–925PubMedCrossRefGoogle Scholar
  39. 39.
    Mihos CG, Santana O, Lamas GA, Lamelas J (2011) Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy. Ann Thorac Surg 91(6):1824–1827PubMedCrossRefGoogle Scholar
  40. 40.
    Arcidi JM Jr, Rodriguez E, Elbeery JR, Nifong LW, Efird JT, Chitwood WR Jr (2011) Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. J Thorac Cardiovasc SurgGoogle Scholar
  41. 41.
    Szwerc MF, Benckart DH, Wiechmann RJ, Savage EB, Szydlowski GW, Magovern GJ Jr, Magovern JA (1999) Partial versus full sternotomy for aortic valve replacement. Ann Thorac Surg 68:2209–2214PubMedCrossRefGoogle Scholar
  42. 42.
    Rebello KJ (2004) Applications of MEMES in surgery. Proc IEEE 92:43–55CrossRefGoogle Scholar
  43. 43.
    Himpens J, Leman G, Cardiere GB (1998) Telesurgical laparoscopic cholecystectomy. Surg Endosc 12:1091PubMedCrossRefGoogle Scholar
  44. 44.
    Rovetta A, Sala R, Cosmi F, Wen X, Sabbadini D, Milanesi S, Toqno A, Angelini L, Bejczy AK (1993) Telerobotics surgery in a transatlantic experiment: application in laparoscopy. In: Kim WS (ed) Telemanipulator technology and space telerobotics. Proceedings of SPIE, vol 2057. pp 337–344Google Scholar
  45. 45.
    Wang Y, Sackier J (1994) Robotically enhanced surgery: from concept to development. Surg Endosc 8:63–66PubMedCrossRefGoogle Scholar
  46. 46.
    Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner ES, Smith KM (2001) Transatlantic robot-assisted telesurgery. Nature 413:379–380PubMedCrossRefGoogle Scholar
  47. 47.
    Falk V, Walther T, Autschbach R et al (1998) Robot-assisted minimallyinvasive solo mitral valve operation. J Thorac Cardiovasc Surg 115:470–471PubMedCrossRefGoogle Scholar
  48. 48.
    Reichenspurner H, Damiano RJ, Mack M, Boehm DH, Gulbins H, Detter C et al (1999) Use ofthe voice-controlled and computer-assisted surgical system ZEUS for endoscopic coronaryartery bypass grafting. J Thorac Cardiovasc Surg 118(1):11–16PubMedCrossRefGoogle Scholar
  49. 49.
    Modi P, Rodriguez E, Chitwood WR Jr (2009) Robot-assisted cardiac surgery. Interact Cardiovasc Thorac Surg 9:500–505PubMedCrossRefGoogle Scholar
  50. 50.
    Chitwood WR, Rodriguez E, Chu MWA, Hassan A, Ferguson TB, Vos PW, Nifong LW (2008) Robotic mitral valve repairs in 300 patients: a single center experience. J Thorac Cardiovasc Surg 136:436–441PubMedCrossRefGoogle Scholar
  51. 51.
    Argenziano M, Katz M, Bonatti J, Srivastava S, Murphy D, Poirier R, Loulmet D, Siwek L, Kreaden U, Ligon D (2006) TECAB trial investigators. Results of the prospective multicenter trial of robotically assisted totally endoscopic coronary artery bypass grafting. Ann Thorac Surg 81(5):1666–1674PubMedCrossRefGoogle Scholar
  52. 52.
    Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS (2010) Predictors of mitral valve repair: clinical and surgeon factors. Ann Thorac Surg 90(6):1904–1911PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  1. 1.Cardiac Surgery Unit, Department of Cardiovascular ScienceSan Bortolo HospitalVicenzaItaly

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