Total 3d endoscopic approach to complete repair of Ebstein’s anomaly: a case series

Ebstein anomaly is a rare congenital malformation of the tricuspid valve. Although robotic-assisted minimally invasive repair has shown promising results, its high cost limits accessibility in developing countries. We report our initial experience with a totally endoscopic cone repair using three-dimensional (3D) visualization and standard thoracoscopic instruments, performed without robotic assistance, for the treatment of Ebstein anomaly. This retrospective case series included five adult patients who underwent total 3D endoscopic tricuspid valve cone reconstruction at E Hospital, Hanoi, between November 2023 and May 2025. Pre- and postoperative echocardiographic parameters, operative data, and early clinical outcomes were analyzed. All patients successfully underwent cone reconstruction without conversion to sternotomy or operative mortality. The mean cardiopulmonary bypass and cross-clamp times were 173.8 ± 32.3 and 131.6 ± 27.3 min, respectively. Postoperative echocardiography demonstrated marked reduction in tricuspid regurgitation, decreased right ventricular diameter, and preserved left ventricular function. The mean ICU stay was 32.8 ± 8.7 h, and the mean hospital stay was 6.2 ± 1.1 days. No major complications were observed. Total endoscopic cone repair with 3D visualization, performed without robotic assistance, is a safe and feasible alternative for Ebstein anomaly repair. This technique provides excellent visualization and surgical precision while avoiding the financial and infrastructural constraints of robotic systems, making it particularly valuable in resource-limited settings.