A novel ‘two-window’ technique to facilitate totally 3D-endoscopic mitral valve repair

  • Soh HosobaEmail author
  • Toshiaki Ito
  • Kenta Zaikokuji
How To Do It


We describe our experience of a novel ‘two-window’ technique designed to assist in totally 3D-endoscopic mitral valve repair. A 10-mm trocar for a 3D-endoscope was inserted through the 4th intercostal space in the mid-axillary line. A main small incision (3 cm, 4th intercostal space) without rib spreading, and a second 1 cm incision (1–2 intercostal spaces above,) were made in the anterior axillary line. Soft tissue retractors were applied on both ports. A left atrial retractor, a left ventricular vent, and right-hand instruments were inserted through the main working port. A flexible aortic cross-clamp, an antegrade cardioplegia line, and left-hand instruments were inserted through the second port. Our two-window technique is safe, effective, and reproducible for totally endoscopic mitral valve repair.


Mitral valve repair Totally endoscopic surgery Minimally invasive cardiac surgery 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Vermeulen Y, et al. From classical sternotomy to truly endoscopic mitral valve surgery: a step by step procedure. Heart Lung Circ. 2003;12(3):172–7.CrossRefGoogle Scholar
  2. 2.
    Murphy DA, Moss E, Binongo J, Miller JS, Macheers SK, Sarin EL, et al. Expanding role of endoscopic robotics in mitral valve surgery: 1,257 Consecutive Procedures. Ann Thorac Surg. 2015;100(5):1675–81.CrossRefGoogle Scholar
  3. 3.
    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;51:913–8.CrossRefGoogle Scholar
  4. 4.
    Holzhey DM, Seeburger J, Misfeld M, Borger MA. Mohr FW Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation. 2013;128:483–91.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryToyohashi Heart CenterToyohashiJapan
  2. 2.Department of Cardiovascular SurgeryNagoya Red Cross First HospitalNagoyaJapan

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