2. editorial
Mayo Clin Proc. • September 2011;86(9):834-835 • doi:10.4065/mcp.2011.0477 • www.mayoclinicproceedings.com 835
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedingsa .
obviously based on observation studies and not on random-
ized trials.
Our experience with the DaVinci robotic system (ie,
the system also used by Suri et al) in the performance
of minimally invasive mitral valve surgery continues to
be positive and satisfying, encompassing more than 200
patients with 1 death and 2 permanent strokes. Yes, there
is room for improvement in the robotic arena. There is still
only one company in the world that makes the robotic sys-
tem (Intuitive Surgical, Inc, Sunnyvale, CA) and thus no
competition in the field. The price for the robotic system is
arbitrarily too high and limits the number of units that any
institution can have available. Improvements need to be
made in the instrumentation. For example, a third robotic
mitral retractor is needed to retract the posteromedial atrial
fold and expose the posterior medial portion of the valve
much more effectively than what is currently available. All
these issues will ultimately be resolved, and I believe that
the robotic approach will continue to provide an alterna-
tive to other minimally invasive techniques for mitral valve
surgery.
Robotic-assisted mitral valve surgery may eventually
become the standard of care in the United States. More work
needs to be done to improve surgical outcomes and to re-
duce postoperative complications. Given that most of these
patients with degenerative mitral valve disease are young,
the eventual complication rate from this procedure should
approach zero. I applaud Suri et al for their impressive
results and for getting close to this goal of a zero complica-
tions rate.
Alfredo Trento, MD
Director, Division of Cardiothoracic Surgery
Cedars-Sinai Heart Institute
Los Angeles, CA
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