One-Inch Incision Totally Endoscopic AVR via a Lateral Approach

A cardiopulmonary bypass was established through a groin incision. A 10 mm trocar for a 3D-endoscope was inserted through the fourth intercostal space at the midaxillary line. A main small incision (2.5 cm, fourth intercostal space) without rib spreading was made at the anterior axillary line. A 5 millimeter port was also inserted at two intercostal space above. An extra small soft tissue retractor was applied on the incision. A left ventricular vent, a flexible aortic cross-clamp, antegrade cardioplegic line, and right-hand instruments were inserted through the main working port. Left hand instruments were inserted through the 5 mm port. After cross-clamp, the aorta was opened. Antegrade selective cardioplegia was administrated, and leaflets were excised. A mechanical valve was implanted with everting mattress stitches. Valve stitches were tied with a knot-pusher. The aorta was closed in two layers. The aortic clamp time, cardiopulmonary bypass time, and total operation times were 109, 160, and 210 minutes, respectively. The patient had an uneventful convalescent and was discharged from the hospital on postoperative day four. Totally 3D endoscopic AVR is a safe, effective, and reproducible technique with excellent cosmetic result.

References

1. Tokoro M, Sawaki S, Ozeki T, Orii M, Usui A, Ito T. Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis. Interact Cardiovasc Thorac Surg. 2020 Mar 1;30(3):424-430.
2. Ito T, Maekawa A, Hoshino S, Hayashi Y, Sawaki S, Yanagisawa J, et al. Three-port (one incision plus two-port) endoscopic mitral valve surgery without robotic assistance. Eur J Cardiothorac Surg. 2017 May 1;51(5):913-918.

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