Objective: To demonstrate the technique of totally endoscopic robotic repair of partial atrioventricular septal defect with complex mitral valve reconstruction in an adult patient. Key Steps: Totally endoscopic robotic approach with peripheral cannulation and bicaval control. Bovine pericardial patch closure of the primum atrial septal defect. Left atriotomy for optimal mitral valve exposure. Leaflet shaving, cleft closure, autologous pericardial augmentation, and flexible annuloplasty. Potential Pitfalls: Inadequate exposure may compromise assessment of the cleft and leaflet pathology. Careful leaflet remodeling, preservation of leaflet mobility, and avoidance of excessive tension during cleft closure are essential to prevent residual regurgitation or mitral stenosis. Take-Home Messages: Totally endoscopic robotic repair enables safe and reproducible treatment of partial atrioventricular septal defect with complex mitral valve reconstruction in selected adults. Enhanced visualization and instrument dexterity facilitate precise intracardiac repair while avoiding median sternotomy.
