Totally endoscopic mitral valve repair using a robotic-controlled atrial retractor.

Purpose: Our aim was to assess the feasibility of totally endoscopic robotic mitral valve surgery using a novel atrial retractor manipulated by a fourth arm da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA).
Description: Eighteen patients with mitral valve disease underwent totally endoscopic mitral valve surgery using the retractor. It was inserted in the second or third intercostal space just lateral to the sternum, and it was manipulated at the robotic console for dynamic exposure of the valve structures.
Evaluation: Mitral valve repair procedures were feasible in all patients with the robotic-controlled atrial retractor providing superior exposure of the mitral valve anatomy. The time until satisfactory exposure of the mitral valve was noticeably decreased with the robotic retractor. All patients were discharged home in sinus rhythm and transesophageal echocardiography revealed competent mitral valves.
Conclusions: The EndoWrist atrial retractor (Intuitive Surgical Inc) facilitated complex totally endoscopic mitral valve surgery, including concomitant procedures, regardless of pathology with excellent clinical outcomes.