The Cardiothoracic Surgery Department at NYU Langone Medical Center—already one of the few programs on the East Coast that performs robot-assisted cardiac surgery—is now the only medical center in the New York area to offer endoscopic robotic mitral valve repair. This procedure was introduced at NYU Langone this past spring by Dr. Didier Loulmet, who performed the world's first robotic mitral valve repair with Dr. Alain Carpentier in 1998.
"Endoscopic robotic mitral valve repair is now my technique of choice for patients with degenerative mitral valve disease," says Dr. Loulmet. "The cardiac surgery team at NYU has one of the most experienced at treating mitral valve diseases, having already performed less-invasive mitral valve repairs in thousands of patients. The adoption of robot-assisted technology represents a natural evolution."
Traditional open-heart surgery to repair a leaky mitral valve was developed in the 1970s, and is still the most commonly used approach. However, It requires a 10-inch incision through the sternum (breastbone) and significant open chest retraction. Unlike the traditional approach, endoscopic robotic mitral valve repair is performed through five small port holes made between the ribs on the right side of the chest. By avoiding a large incision with chest retraction, patients have less blood loss, less wound infection, experience less post-operative pain, recover more quickly, and have a much nicer cosmetic result. "When I see patients three months after they've undergone a robotic mitral valve repair, it's hard to tell they've had heart surgery," notes Dr. Loulmet.
"The da Vinci surgical robot has evolved through several generations of systems since 1998, and the latest generation has a number of new features that facilitate endoscopic mitral valve repair," adds Dr. Loulmet. "For instance, the system's additional fourth arm is used as an articulated left atrial retractor that optimizes the exposure of the mitral valve. This, combined with other features like the da Vinci's 3-D magnified vision and its highly maneuverable articulated instruments, give us the ability to perform complex mitral valve repairs with a high precision."
NYU's cardiac surgeons are also among the nation's leaders in robot-assisted coronary artery bypass surgery. Similar to robot-assisted mitral valve repair, robotic bypass surgery can be performed through a series of small incisions between the ribs. "As with mitral valve repair, the da Vinci's technological improvements allow heart surgeons to perform more complex coronary artery bypass procedures," says Dr. Loulmet. "This approach can be effectively used in combination with percutaneous angioplasty to perform more complete revascularization. This new combined approach is known as the hybrid procedure and is performed in our new, state-of-the-art hybrid operating room."
At the same time, NYU Langone's thoracic surgeons, led by Dr. Michael Zervos and Dr. Costas Bizekis, are now using robotic technology for a growing number of their thoracic procedures, including endoscopic pulmonary lobectomies.
"Our cardiothoracic surgeons are known for their pioneering works in minimally-invasive cardiac and thoracic surgery," says Dr. Aubrey Galloway, chair of Cardiothoracic Surgery. "Due to the significant improvements in robotic technology, we're taking our tradition to the next level."