[Current Situation of Robot-assisted Cardiac Surgery:Start-up and Ingenuity for Stabilizing Results].

In Japan, the medical fee revision in April 2018 allowed insurance coverage for robot-assisted cardiac surgery for mitral and tricuspid valve plasty. We started robot-assisted mitral valve plasty by da Vinci system in June 2019. The artificial chordae reconstruction by the loop method, which has been our basic surgical technique so far, has also been adopted in robot-assisted cardiac surgery. The author has performed three dimensional( 3D) endoscopic minimally invasive cardiac surgery( MICS), but now focuses on robot-assisted cardiac surgery because of the delicate procedure and good operability. The venous drainage cannulation through the femoral vein is done under fluoroscopy. We use a silicon cylinder, that is elastic and provides a wide field of view, to approach to the papillary muscle. Robot-assisted cardiac surgery, which takes a little longer than through a mid-sternum incision, requires some ingenuity to save time. We also mention cadaver training that had to be experienced abroad, such as robot training with a human body donation that will start soon at our hospital.