Objective: To report the initial clinical experience, technical feasibility, and short-term safety outcomes of robotic-assisted totally endoscopic mitral valve repair (R-TEMVR) in the early phase of adopting this technology.

Methods: A prospective observational study was conducted on 6 consecutive patients who underwent R-TEMVR for degenerative mitral regurgitation at our institution from September 2025 to December 2025. All procedures were performed using the Da Vinci Xi Surgical System by a single surgical team with prior experience in 3D endoscopic mitral valve surgery and robotic assisted MICS CABG but new to robotic cardiac valve surgery. Perioperative variables recorded included operative time, CPB time, aortic cross-clamp (ACC) time, postoperative intensive care unit (ICU) stay duration, hospital length of stay (LOS), bleeding requiring transfusion, cerebrovascular accident [CVA], mortality).

Results: All 6 patients successfully completed R-TEMVR without conversion to sternotomy. The median (interquartile range, IQR) operative time was 230-340minutes, median CPB time was 145-275 minutes, and median ACC time was 114-189 minutes. A downward trend in CPB and ACC times was observed across the case series. 

Conclusions: In the early phase of adopting R-TEMVR, this initial observational study demonstrates that the procedure is technically feasible and safe for selected patients with mitral regurgitation, even for surgical teams transitioning from 3D endoscopic to robotic surgery.

Dr Sheng Wang, MD PhD,Chief Physician, is director of minimal invasive cardiac surgery departmen,Performing 350 cases per year, including around 280 minimal invisive cardiac surgery cases（90 endoscopic valve surgeries，180 robotic assisted CABD，10 robotic totally endoscopic MVP.