Specialist Procedures

Mr Paul Modi MD FRCS is a British, US and German-trained consultant cardiac surgeon with expertise in minimally invasive (keyhole) and robotic heart surgery.

Da Vinci robotic mitral valve surgery

Robotically assisted mitral valve surgery is a type of minimally invasive heart surgery performed by a cardiac surgeon on the mitral valve using an endoscopic, closed chest approach. The mitral valve is one of four valves in your heart and lies between the upper and lower pumping chambers on the left side of your heart (between the left atrium and left ventricle). Most commonly, the mitral valve is regurgitant or leaky, when the strings (chordae tendinae) holding the valve down inside the heart break or become elongated. Most regurgitant valves can be repaired. Some mitral valves can however become stiff and fused (stenotic), particularly if you have had rheumatic fever when you were younger, and these are more commonly replaced with artificial valves. If you require mitral valve surgery, either repair or replacement, you may be a candidate for robotically assisted mitral valve surgery.

Traditional open chest surgeries involve dividing the sternum (breastbone) and spreading the ribs to view the heart and obtain access to operate on the mitral valve. This takes about 8 to 12 weeks to recover from, with no lifting of anything heavier than a bag of sugar for the first 6 weeks.

Traditional sternotomy

Robotic mitral valve surgery







Robotic mitral valve surgery involves making five tiny incisions between the ribs (four of these only 8mm in length) and then using these incisions to place the Da Vinci robot arms through the chest wall. The movements of the robotic arm, wrist, hand and fingers mimic and even outperform those of the surgeon’s to perform very intricate surgery using 10x magnification and 3D vision inside the heart. They allow us to perform the same steps as traditional mitral valve surgery but with surgical incisions only millimetres in length. This is called the LEAR technique (Lateral Endoscopic Approach for Robotics) and was popularised by Dr Doug Murphy from Atlanta, USA, a master robotic cardiac surgeon. The LEAR technique has made a massive difference to the speed of recovery of patients, and it is only with this expensive Da Vinci technology that the degree of surgical trauma can be reduced to an absolute minimum. It is a game changer in the delivery of mitral valve surgical care and we are fortunate at Liverpool Heart and Chest Hospital to be the only cardiothoracic centre in the UK to have the latest Da Vinci X system just for heart and lung surgery.

What are the benefits of Da Vinci robotic mitral valve surgery?

  • Smaller incisions with minimal scarring
  • Less pain
  • Shorter hospital stay (usually 2 to 4 days)
  • Decreased use of pain medications
  • Less bleeding
  • Decreased risk of infection
  • Shorter recovery and quicker return to daily and professional activities: The patient can resume normal activities and work as soon as he or she feels ready; there are no specific activity restrictions after robotically-assisted surgery. The DVLA still does not let you drive for 4 weeks.

The cosmetic result of Da Vinci robotic mitral valve surgery


Day 2 after a robotic mitral valve repair


Four days after robotic mitral valve repair


More information

Intuitive Surgical – Click here to view PDF