Robotic mini-thoracotomy approach to aortic valve and ascending aorta replacement

Fully endoscopic robotic-assisted aortic valve replacement has emerged as a safe, reproducible and effective minimally invasive approach with favourable clinical outcomes. In patients undergoing aortic valve surgery, concomitant ascending aortic aneurysms should be addressed whenever indicated, as failure to do so may lead to serious long-term aortic complications. Currently these patients must undergo some form of sternotomy to address both pathologies. The use of a totally robotic minithoracotomy approach for concomitant aortic valve and ascending aortic replacement has not, to our knowledge, been previously reported. This video tutorial highlights a robotic approach for combined aortic valve and ascending aortic replacement, representing a pioneering step in the evolution of complex robotically assisted aortic surgery. Our vision is to develop a robotic aortic surgery programme that maintains the safety, efficacy and durability of conventional techniques while significantly expediting postoperative recovery for selected patients.