In recent decades, minimally invasive surgery has gained wide acceptance because it presents many benefits such as pain reduction, minimization of surgical trauma, shorter hospital stays, faster return to normal activities and improvement of cosmesis. At the same time, great progress has been made in minimally invasive approaches thanks to improvements in surgical instrumentation, perfusion technology and visioning platforms. For these reasons, in several institutions around the world, minimally invasive procedures are considered the standard of care.

One disadvantage of minimally invasive surgery is the limitations of long-shafted endoscopic instruments, but this is being successfully dealt with the development of robotic telemanipulators, which provide three-dimensional (3D) vision and articulating instruments with seven degrees of freedom of motion, equivalent to a human hand.

The DaVinci system, with its enhanced 3D visual feedback, achieves similar results due to the observation of tissue displacement and deformation. The high-definition 3D imaging, provided by the system, significantly improves operative visualization, especially with regard to visualization of the mitral valve and subvalvular system compared to endoscopic minimally invasive approaches. Another advantage of the DaVinci system is the increased operative dexterity it provides to surgeons due to the robotic instruments, which allow tremor-free, ambidextrous movements and avoidance of the fulcrum effect (which is interwoven with the use of long-shafted endoscopic instruments).

In particular, robotic mitral valve surgery has become over the last decade the method used by some specialized centers worldwide, given the great evolution and the excellent results it has shown. Robotic single-vessel and double-vessel total endoscopic coronary artery bypass grafting procedures have been standardized on both the beating and the arrested heart, and numerous other cardiac procedures are in various stages of development. To date, the results are equivalent to those of the major trials for sternotomy-based procedures. An additional advantage is a shorter hospital stay and return to previous activities.

Robotic operations are becoming increasingly simple and effective thanks to advances in robotic technology and procedure development.

• Endoscopic cardiac surgical procedures. Through a few centimeters keyhole incision on the right side of the chest, without cutting the breastbone, and with the use of 3D HD endoscopes we treat diseases of the mitral valve, the tricuspid valve, we resect cardiac tumors (like myxomas) and close atrial septal defects.
• Robotic-assisted and hybrid coronary artery bypass grafting (CABG). Through a few centimeters keyhole incision on the left side of the chest, without cutting the breastbone, and with the use of a Robotic DaVinci console we can perform coronary artery bypass grafting procedures as a standalone or hybrid procedure with the combination of percutaneous coronary intervention (stents) on the same sitting.
• Aortic valve minimally invasive surgery. Through a few centimeters mini-sternotomy, without cutting the full length of the breastbone, we can perform aortic valve replacement.
• Transcatheter valve replacements. Without any incisions, for patients that fulfil the criteria, we perform transcatheter aortic and mitral valve procedures.

All the above procedures are considered state-of-the-art, and result in smaller trauma, less postoperative pain, reduced hospital stay, reduced need for transfusions, excellent cosmesis and , most importantly, a swift recovery and quick return to normal activities and lifestyle.