Dr. Raczkowski explains how the da Vinci® robot helps to improve valve repairs.
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Benefits of using the da Vinci Valve Repair Robot Valve repairs, which primarily consist of making the natural valve perform the way it’s supposed to, i.e. not leaking, which is the most common thing, the regurgitation, requires very precise understanding of valve pathology. But also during the conduct of the operation, the ability to see the valve in its natural state, without question, improves the accuracy of the repair, which is the most important thing that you are doing when you are trying to repair a valve and get it back to its normal physiologic state, its normal function. The da Vinci® robot provides a binocular stereoscopic view, which can be enlarged ten times by the push of a button. The view of the valve from the location of the camera is unprecedented. You never see the entire valve like you do with a minimally invasive robotic approach say, through the standard anterior or sternotomy approach. Those of us who do the robotic mitral valve repairs with the da Vinci® robot will always tell you that our repairs are much better because we can see so much better, and your ability to evaluate the valve to make sure your repair was done properly obviously will contribute to the success of the procedure. Using the da Vinci® robot for minimally invasive valve surgery allows us the unique opportunity to visualize the valve just as if we are standing inside the heart. When we do a normal operation, it’s trying to observe something from afar, trying to picture the way the valve would normally relate to the heart because we are distorting the heart to be able to see it. When we use the da Vinci® robot, the view is such, the view would be the same as if you were standing inside the upper chamber of the heart observing the valve in its natural, normal orientation. That’s why I think the precision, which is involved in valve repair, is so much better using the da Vinci® robot. In the traditional approach to mitral valve repair, patients put on the heart-lung machine, which supports all of the circulation. The heart is actually stopped, and during that time you have a bloodless, still field, which allows the surgeon to perform their procedure. Unfortunately, it also distorts the normal anatomy. Going through the front part of the heart, you have to twist the heart 180° to be able to even see the valve so that its normal anatomy, its normal orientation is completely distorted. So you have to anticipate what the valve is going to look like after the repair. If you go through the lateral approach, the lateral side of the chest with the da Vinci® robot, because of the magnification, because of the stereoscopic camera, you are observing the valve in its normal orientation. Its normal anatomical relation to the ventricle and the upper chamber so that it’s much easier and much simpler to repair that valve because you can see those normal relationships. The heart is not having a full load of blood. It’s still being supported by the heart-lung machine, but at Banner Heart, we try to keep the heart still beating because it allows the normal tone of the ventricle to be present and it allows that normal orientation of the valve to be there while we are repairing it. We don’t arrest the heart.
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