僧帽弁形成術における新たな選択肢―ロボット支援下心臓手術がもたらした変化

Robotic Mitral Valve Repair：Clinical Outcomes and Educational Impact at a Single Institution

ロボット支援下心臓手術（以下，ロボット手術）は1985年に行われた脳生検が最初とされている．世界初のロボット手術としては1998年に僧帽弁形成術・冠状動脈手術が行われた．2000年にda Vinci Surgical System（Intuitive Surgical社）が米国食品医薬品局（FDA）に承認され，ロボット手術は急速に普及した．日本では2000年に導入され，制度整備を経て2018年には僧帽弁形成術が，2024年には弁置換術，複数弁手術が保険収載され，その適応は徐々に拡大している．

Mitral valve repair has evolved with the development of minimally invasive approaches, including right mini‑thoracotomy, in addition to conventional median sternotomy, leading to expanded surgical indications. More recently, the introduction of robotic-assisted surgery has provided a new alternative for mitral valve repair. At our institution, robotic mitral valve surgery was initiated in October 2023, and has since been applied not only to isolated mitral valve repair but also to combined procedures involving tricuspid valve repair and arrhythmia surgery. The high-definition three-dimensional visualization and enhanced dexterity of robotic systems facilitate precise manipulation in challenging conditions, including reoperative cases, infective endocarditis, and paravalvular leakage. Furthermore, the ability to visualize and share the operative field in real time, together with stepwise skill transfer enabled by dual-console systems, enhances the understanding and reproducibility of mitral valve repair and allows for safe transmission of surgical techniques. This article reviews the role of robotic-assisted surgery in mitral valve repair and outlines the changes it has brought to both clinical practice and surgical education.