Redefining RVOT Reconstruction: Right Atrial Appendage Valve for ​the ​Pulmonary Position

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The preparation of the right atrial (RA) appendage was done by incising the trabeculae under vision and everting the excised appendage over a Hegar dilator, so that the smooth external aspect of the RA appendage was in the path of blood. Eversion over the Hegar dilator also made dividing the trabeculae safer and the repair of any inadvertent perforation easier.  After clearing the right ventricular outflow tract (RVOT) and closing the ventricular septal defect (VSD) from the…

Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy

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This video shows a step-by-step demonstration of minimally invasive aortic valve replacement through a right anterior minithoracotomy. It focuses on the key technical steps, highlighting  practical nuances and explaining the advantages of this approach. The case presented involved a 79-year-old man who developed progressive dyspnea while hiking in the Alps. Echocardiography showed severe aortic valve stenosis with preserved left ventricular function. Coronary…

Direct Left Main Bypass for Anomalous Left Main Origin With Interarterial Course

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Anomalous origins of the coronary arteries are rare, occurring in 1-2 percent of the general population. While anomalous aortic origin of the coronary artery alone is less often problematic (for example, right coronary artery (RCA) arising cranial to the sinotubular junction (STJ)), anomalous origin with an anomalous proximal course (interarterial or intramuscular)  is more likely to be associated with ischemia.   While RCA origin from the left coronary sinus is the most…

Robotic Resection of a Giant Superior Mediastinal Mass

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This video demonstrates the robotic resection of a giant superior mediastinal mass. The patient was a middle-aged male who had been referred to the authors’ clinic for evaluation of a mediastinal mass discovered on magnetic resonance imaging (MRI) during workup for dorsalgia. Imaging originally demonstrated a large, approximately 7 cm mass in the right upper mediastinum associated with tracheal deviation.   Further workup with computed tomography (CT) of the chest demonstrated similar findings and a small, central, coarse calcification. Positron emission…

Left Atrial and Pulmonary Cuff Dissection After Heart and Lung En-Bloc Procurement

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This video demonstrates pulmonary cuff dissection for combined heart and lung procurement, utilizing an approach in which the pulmonary and left atrial cuffs are carefully dissected and tailored to optimize organ suitability. Maximizing the length and integrity of the left atrial cuff is critical for successful lung transplantation. An inadequate cuff can cause severe technical difficulty, require reconstruction, or even lead to…

Tetralogy Repair in an Infant

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Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases, characterized by a constellation of anatomical abnormalities, including ventricular septal defect, right ventricular outflow tract (RVOT) obstruction, overriding aorta, and right ventricular hypertrophy. Complete surgical repair remains the definitive treatment, and a clear understanding of operative steps is essential for trainees beginning congenital cardiac surgery.  The…

Pigtail Chest Tube Insertion Instructional Video

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Before beginning, it is essential to review the imaging to confirm the correct side and indication for the procedure. Additionally, the labs needed to be reviewed to ensure that there is no underlying coagulopathy that requires correction. This information is then used to obtain informed consent. In this case, the patient was an 80-year-old female who was postoperative day five from a minimally…

Hybrid VATS Right Upper Lobectomy With En Bloc Chest Wall Resection and Thoracoscopic Management of Major Stapler Injury

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The authors present the case of a 71-year-old female former smoker who was referred for persistent right dorsal thoracic pain. Computed tomography (CT) and positron emission tomography (PET) scans revealed a 39 mm hypermetabolic tumor (SUVmax 10) in the apical segment of the right upper lobe, with direct invasion of the second rib. Preoperative staging, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), confirmed N0 status. With a clinical stage IIB (cT3N0M0) tumor, the patient…

Robotic Upper Bilobectomy for Upper Lobe Bronchiectasis With Middle Lobe Adenocarcinoma

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The authors present a robotic-assisted right bilobectomy performed for coexisting right upper lobe bronchiectasis and synchronous middle lobe adenocarcinoma, highlighting the management of dual pathology in the setting of dense inflammatory adhesions. A 45-year-old male with a longstanding history of cough and dyspnea was found to have localized bronchiectasis in the right upper lobe along with a suspicious lesion in…

The Exclusion Technique: An Approach to Parenchymal Division During Complex Robotic Segmentectomy

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Anatomic segmentectomy has emerged as an effective option for the management of early-stage lung cancer; however, the division of intersegmental parenchyma remains technically challenging. The authors describe and illustrate the exclusion technique, a bronchus-last strategy that utilizes an endoleader catheter to guide parenchymal division and simplify segmentectomy. Methods The exclusion technique involves dissection and division…

Left Pulmonary Artery Reimplantation Into the Main Pulmonary Artery

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This is a case presentation of an eight-day-old female who presented with an anomalous left pulmonary artery (LPA) diagnosed by fetal ultrasound. A preoperative transthoracic echocardiogram demonstrated an anomalous LPA located 4 mm above the ascending aortic sinotubular junction, with right ventricular dilation, a mildly diminished right ventricular (RV) systolic volume of 29.6 percent, and RV hypertension (HTN) of 36.36 mmHG. Additionally, there was a patent right ductus arteriosus. This diagnosis was confirmed with a sagittal computed tomography angiography (CTA) scan. Due…

Single-Port Robot-Assisted Left Lower Lobe Common Basal Segmentectomy With Systematic Lymph Node Dissection

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Robotic thoracic surgery provides superior precision and enhanced ergonomics compared to video-assisted thoracoscopic surgery, primarily due to its three-dimensional visualization and wristed instruments. These advantages facilitate meticulous dissection and more comprehensive lymphadenectomy in complex resections, ultimately contributing to improved surgical outcomes (1).  As an advanced evolution of minimally invasive surgery, single-port robotic surgery offers several advantages over multiport robotic…

Robotic-Assisted Diaphragmatic Hernia Repair

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Diaphragmatic defects involving the central tendon are uncommon and may present diagnostic uncertainty, particularly when identified incidentally on imaging. Surgical management can be technically challenging due to attenuated tissue quality and close proximity to vital structures, including the liver and inferior vena cava.  The authors present a video case report with intraoperative footage of a patient undergoing robotic repair of diaphragmatic herniation through a fenestrated…

Self-Constructed Tubular Heart Valve Using Bovine Pericardium for Surgical Treatment of Tricuspid Valve Endocarditis

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Tricuspid valve endocarditis with extensive leaflet destruction presents a major surgical challenge, particularly when durable valve repair is no longer feasible and conventional prosthetic valve replacement may be undesirable. In this video, the authors demonstrate their technique for the surgical treatment of destructive tricuspid valve endocarditis using a self-constructed tubular valve fashioned from bovine pericardium.   After radical debridement of all infected and devitalized…

Redo Robotic Mitral Valve Replacement Using Aortic Cross-Clamping

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The authors report a redo robotic-assisted mitral valve replacement (MVR) in a 50-year-old male with prior bioprosthetic MVR via sternotomy, presenting with New York Heart Association (NYHA) class III dyspnea and significant prosthetic mitral inflow obstruction (mean/peak gradient 10/20 mmHg) with preserved biventricular function. The procedure was performed using a robotic platform with del Nido cardioplegia for myocardial protection, and a mechanical prosthesis…

ROK Procedure for the Treatment of Atrial Fibrillation

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This clinical video provides a detailed, step-by-step overview of the robotic-assisted convergent (ROK AF) procedure for the treatment of atrial fibrillation. The technique combines minimally invasive epicardial ablation with endocardial catheter-based ablation to achieve durable rhythm control, particularly in patients with persistent or long-standing persistent atrial fibrillation. This how-to video is designed to serve as a practical guide…