Sandoval Elena, Morales-Rey Ignacio, Bartolozzi Luis, Pereda Daniel
Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Front Cardiovasc Med. 2023 Oct 6;10:1237151. doi: 10.3389/fcvm.2023.1237151. eCollection 2023.
Robotic mitral repair is generally performed with four intercostal trocars and a minithoracotomy. We describe our technique and results with a totally-thoracoscopic closed chest approach using a 12 mm valveless trocar as "working port", without a minithoracotomy. We compared our results with this technique with a control group of robotic mitral repairs performed earlier with a minithoracotomy.
Review of all patients with degenerative mitral valve disease who underwent robotic mitral valve repair surgery since December 2019 ( = 110). Patients with concomitant procedures ( = 8) were excluded. The remaining 102 patients were divided in two groups, depending on the approach used, minithoracotomy ( = 63) and totally thoracoscopic ( = 39).
There were no significant differences between groups regarding preoperative characteristics. All procedures were completed robotically as planned, and repair rate was 100%. The minithoracotomy group showed a higher percentage of leaflet resections (17.9% vs. 38.7%; = 0.03). All surgical times were significatively reduced in the totally thoracoscopic group: Cardiopulmonary bypass (97 vs. 115 min, = 0.0008), ischemic time (67 vs. 80 min, = 0.0013) and total surgical time (185 vs. 225 min; < 0.00001). There were no differences in ICU length of stay (1 day, = 0.07) but hospital length of stay was shorter in the totally thoracoscopic group (4 days; = 0.0001). Postoperative complications were similar between groups. MR at discharge was mild or less in all cases.
Robotic mitral repair for degenerative disease can be safely performed as a closed-chest procedure, using a 12 mm trocar as "working port" and avoiding the need for a minithoracotomy. This approach does not seem to negatively affect the quality of the procedure by any measure, providing similar excellent clinical outcomes and repair rate. All surgical times were shorter in the closed-chest group.
机器人二尖瓣修复术通常通过四个肋间套管针和一个小切口开胸手术进行。我们描述了我们使用一个12毫米无瓣膜套管针作为“工作端口”的全胸腔镜闭式胸腔入路技术及结果，无需小切口开胸手术。我们将采用该技术的结果与早期采用小切口开胸手术的机器人二尖瓣修复术对照组进行了比较。
回顾自2019年12月以来接受机器人二尖瓣修复手术的所有退行性二尖瓣疾病患者（n = 110）。排除同期进行其他手术的患者（n = 8）。其余102例患者根据所采用的入路分为两组，小切口开胸手术组（n = 63）和全胸腔镜手术组（n = 39）。
两组患者术前特征无显著差异。所有手术均按计划通过机器人完成，修复率为100%。小切口开胸手术组的瓣叶切除率更高（17.9%对vs. 38.7%；P = 0. = 0.03）。全胸腔镜手术组的所有手术时间均显著缩短：体外循环时间（97对115分钟，P = 0.0008）、缺血时间（67对80分钟，P = 0.0013）和总手术时间（185对225分钟；P < 0.00001）。重症监护病房住院时间无差异（1天，P = 0.07），但全胸腔镜手术组的住院时间较短（4天；P = 0.0001）。两组术后并发症相似。出院时的二尖瓣反流均为轻度或更低程度。
对于退行性疾病，机器人二尖瓣修复术可作为闭式胸腔手术安全进行，使用12毫米套管针作为“工作端口”，无需小切口开胸手术。该方法似乎在任何方面都不会对手术质量产生负面影响，提供了相似的优异临床结果和修复率。闭式胸腔手术组的所有手术时间更短。
