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Totally 3D Endoscopic Mitral Valve repair
Hirokazu Niitsu, Takahiro Takemura, Takahito Yokoyama, Yujirou Kawai, Yasuyuki Toyota, Yasutoshi Tsuda.
Saku Central Hospital, Saku, Japan.

OBJECTIVE: Minimally invasive mitral valve surgery has s significant advantages of minimizing surgical trauma. This procedure is a wildly used technique with endoscopic assist. However robotic assist is used for totally endoscopic procedure in many institution. We performed fully 3D endoscopic procedure through 5-7cm right mini-thoracotomy without rib spreading and robotic assist from January 2013. We present the results of our early experience.
METHODS: From January 2013 to December 2015, a total of 27 patients underwent full 3D endoscopic mitral repair for severe degenerative mitral regurgitation or functional mitral regurgitation. The procedure was performed 5cm skin incision in male patients and 7-8cm inframammary skin incision in female patients using soft tissue retractor. And 11mm endoscopic port, 5mm thoracic port and trans thoracic aortic clamp were used.
RESULTS: ulmonary bypass time and cross clamp time were 152±40 minutes and 99±23 minutes, respectively. Resection techniques performed in 10 patients and chordal replacement performed in 10 patients. Combined procedure for both leaflets underwent in 3 patients.Ring annuloplasty was combined with those procedures in all patients. 2 patients underwent annuloplasty alone. Endocardial surgical Cox-Maze ablation for left atrium using pen type radiofrequency device was performed in 6 patients with persistent atrial fibrillation. No patients required conversion to sternotomy. There was no mortality and no re-exploration due to bleeding. All patients had no severe operative pain. 23 patients had no or trivial mitral regurgitation and 2 patients had mild regurgitation at discharge. 1 patients required re-operation due to recurrence of moderate regurgitation and 1 patients required due to hemolysis 2 month after operation.
CONCLUSIONS: We performed standard mitral valve repair techniques using 3D endoscope with good visualization. This procedure is safe and cost effective technique compared with robotic mitral surgery.

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