The marriage of a medical imaging system and a robot makes the benefit of minimally invasive interventions substantial. An MRI compatible robotic assistant system was developed for assisting in normally transapical aortic valve replacement. Different interfaces were implemented to suit the needs at the different phases of TAVR procedure. The experimental results show that this robotic system can assist to smoothly deliver the prosthesis under real-time MRI guidance with high accuracy. The presence and motion of the robotic system inside the MRI scanner were found to have no noticeable disturbance to the image. The performance of using interactive interface to control the robotic system in a beating heart is under further evaluation in an animal study.

With the assistance of improvements in engineering technologies such as medical imaging, surgical navigation, and robotic devices, more cardiac surgeries can be performed in a minimally invasive fashion. We believe minimally invasive cardiac technique development is a long evolutionary process; it requires collaborative efforts of physicians and engineers to work cooperatively to fill in the technological gaps. Acknowledgment The authors are supported through the Intramural Research Program of the National Heart, Lung, and Blood Institute, NIH, DHHS.
Between February 2010 and April 2011, a trained surgeon in advanced laparoscopic surgery (RV and JMF) performed 32 consecutive robotic sleeve gastrectomies (RSGs) for the treatment of morbid obesity. Patients were included according to the waiting list inclusion and all meet the criteria for sleeve gastrectomy.

The surgical team consisted of two attending physicians who shared the console and the scrubbed table activities. R. Vilallonga trained in a pig model performing 10 nephrectomies prior to beginning the RSG. The two surgeons worked consistently within the same roles; R. Vilallonga was in the console and J. M. Fort at the patient’s side in all cases. The study adhered to all ethical guidelines considered in our institution. 2.1. Pneumoperitoneum and Trocar Placement The Veress needle technique was used to establish the pneumoperitoneum into the left hypochondrium. A 12mm port was inserted 120mm inferior and slightly left to the sternum for camera access. For the latter port, we used an extra large 150mm long trocar (Xcel trocar, Ethicon-Endosurgery, Cincinnati, OH, USA).

The right 12mm working port was positioned 6cm from the midline trocar. The left 12mm working port was located 6cm to the left of the midline trocar. An 11mm trocar was placed laterally to the left hypochondrium (to allow the table assistant to assist and also to place the left arm of the robot during surgery) and an 8mm da Vinci GSK-3 trocar was placed under the right hip as laterally as possible (anterior axillary line) to allow liver retraction. The 8mm da Vinci trocars were inserted through standard, disposable 12mm trocars.