Robot-assisted neck incision technique “least-invasive” aortic valve surgery
Four patients who underwent robot-assisted aortic valve replacement (AVR) through a small incision in the neck were able to resume unrestricted activity within a week, reporting minimal pain during recovery. Cleveland Clinic cardiothoracic surgeon Dr. Marijan Koprivanac, who performed the surgeries earlier this year, presented the results at the American Association for Thoracic Surgery annual meeting in May. This is the first known clinical report of transcervical robotic AVR.
Dr. Koprivanac said the new approach could offer the benefits of surgical AVR without the prolonged recovery typical of other methods. Traditional AVR via sternotomy is still considered the standard, but newer techniques like mini-sternotomy, thoracotomy, and robotic-assisted access have made surgery less invasive. The transcervical method further reduces trauma by avoiding chest incisions altogether.
Dr. Koprivanac adapted the technique from his experience with transcervical thymectomies, accessing the aortic valve through a small neck incision. He refined the procedure on cadavers at the Cleveland Clinic Lerner Research Institute, then moved to clinical application after confirming feasibility.
The four patients, aged 60 to 74, received either a Perceval L or Inspiris Resilia valve. Average cross-clamp time was 140 minutes. Three patients were discharged within 4 days, while one stayed six days due to heart block requiring a pacemaker. All reported low pain levels and managed recovery with over-the-counter medication.
Patients returned to active lifestyles quickly. One resumed gym workouts a week after surgery; another was back to farm work by week three. “Such early activity is rarely possible with other AVR techniques,” said Dr. Koprivanac.
Dr. Marc Gillinov, Chair of Thoracic and Cardiovascular Surgery, and Dr. Samir Kapadia, Chair of Cardiovascular Medicine, called the approach a major advancement in minimally invasive heart surgery.
The team is now working to reduce cross-clamp time to around 60 minutes and exploring new instruments to improve efficiency in tight spaces. Although some patients could have been discharged on day two, they were kept longer for monitoring due to the procedure’s novelty.
Dr. Koprivanac aims to standardize the technique for specialized centers, emphasizing safety as the top priority. “The results are encouraging, and we’re committed to refining the procedure to help more patients recover faster and with less pain,” he said.
Category: Technology & Devices
