McClure R Scott, Kiaii Bob, Novick Richard J, Rayman Reiza, Swinamer Stuart, Kodera Kojiro, Menkis Alan H
Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, University of Western Ontario.
Can J Surg. 2006 Jun;49(3):193-6.
Investigation into the surgical application of robot technology continues to expand. We report on the first case series of robotic-assisted mitral valve (RAMV) repair in Canada with use of the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, Calif.).
Between February 2004 and August 2004, 10 patients with normal left ventricular function and severe mitral valve regurgitation underwent RAMV repair with use of the da Vinci system. Peripheral cardiopulmonary bypass, transthoracic aortic cross-clamping and antegrade cardioplegia were used in all cases. A minithoracotomy in the fourth intercostal space and 2 ports in the third and fifth intercostal spaces allowed surgical access. All mitral valve valvuloplasties and band annuloplasties were done endoscopically with robotic assistance.
Nine of 10 patients had successful valve repair, and 1 had conversion to mitral valve replacement due to persistent regurgitation. There were no deaths, strokes or need for sternotomy. One patient required re-exploration for bleeding.
Minimally invasive RAMV repair is feasible and safe with promising early postoperative results when performed by experienced surgical personnel accomplished in both mitral valve procedures and robotic techniques.
机器人技术在外科手术中的应用研究仍在不断拓展。我们报告了加拿大首例使用达芬奇远程操作系统（直观外科公司，加利福尼亚州森尼韦尔市）进行机器人辅助二尖瓣修复的病例系列。
2004年2月至2004年8月期间，10例左心室功能正常且患有严重二尖瓣反流的患者接受了使用达芬奇系统的机器人辅助二尖瓣修复手术。所有病例均采用外周体外循环、经胸主动脉阻断和顺行性心脏停搏。在第四肋间进行小切口开胸，并在第三和第五肋间设置2个端口以进行手术操作。所有二尖瓣成形术和带环成形术均在机器人辅助下通过内镜完成。
10例患者中有9例瓣膜修复成功，1例因持续反流而转为二尖瓣置换术。无死亡、中风病例，也无需进行胸骨切开术。1例患者因出血需要再次手术探查。
对于经验丰富、精通二尖瓣手术和机器人技术的外科人员来说，微创机器人辅助二尖瓣修复是可行且安全的，术后早期效果良好。
