Initial Experience of Robotic Mitral Valve Surgery in Korea Sung Woo Cho, Jae Won Lee Departement of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Background Traditionally, mitral valve surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and techniques have resulted in increase of minimally invasive mitral valve operation using voice controlled camera-holding robotic arm. This equipment was introduced in Korea for the first time on 2004. Methods Between April 2004 and Jun 2004, 15 patients underwent robot-assisted minimally invasive mitral valve surgery via 5cm right lateral microthoracotomy using voice controlled robotic arm(AESOP 3000, Automated Endoscope System for Optimal Positioning), femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Intraoperative transesophageal echocardiography was performed in all patients. For pain control, epidural PCA and 4th, 5th intercostal nerve block by cryoablation were performed. Results Mitral valve repair was performed in 12 patients, and valve was replaced in 3 patients with prosthetic valve. Co-procedures were Maze op( 4 patients ), Maze + TAP( 3 patients ), TAP( 1 patient ). Mean CPB time was 174.5 minutes, mean ACC time was 114.4 minutes. Median hospital stay was 9 days(range 3 to 30), but median hospital stay was 5 days(range 3 to 6) in 7 patients with isolated mitral surgery. One patient was required by reoperation for bleeding. There was no hospital mortality. Conclusions The use of a voice controlled robotic arm to guide the videoscope has not only enhanced visualization by providing a stable, tremor-free image but also obviated the need for assisting personnel. Our experience of robot-assisted minimally invasive mitral valve surgery suggests that many surgeons will be able to perform minimally invasive mitral operation through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the results of robot-assisted operation.