Non-rib-spreading Totally Endoscopic Mitral Valve Repair Using 3D Camera
Minimally invasive cardiac surgery (MICS) for mitral valve repair has been performed successfully over the past decade. However postoperative pain related to rib-spreading violates the value of MICS. Although robot-assisted mitral valve repair is one of the least invasive way, it has been limited by the cost involved. We review the early results of our totally endoscopic procedure using the 3D camera(SHINCO OPTICAL Co. ltd, Tokyo, Japan).
From January 2013 to December 2015, 27 patients underwent totally 3D endoscopic mitral repair for severe degenerative mitral regurgitation or functional mitral regurgitation. Under general anesthesia with one-lung ventilation, a right anterior mini-thoracotomy in the 4th intercostal space is made. We use a soft tissue protector without a rib spreader. The 3D camera is inserted laterally in the same space. CPB is established with femoral(axillary) cannulation. The ascending aorta is cross-clamped with transthoracic clamp.
Non-Rib-Spreading totally 3D endoscopic mitral valve repair provided very satisfactory early results, with 100％ repair rate without MACCE or conversion to sternotomy. It is noteworthy that no patient had a postoperative severe pain. We think that 3D endoscopic visualization is a helpful tool providing us a depth perception and a detailed overview. Having these, inspection and repair of mitral valve are easier.
Based on our experience, Non–Rib-Spreading totally 3D endoscopic mitral valve repair provides effective and painless treatment without robotic assistant.