Prior minimally invasive experience and the robotic mitral valve learning curve: a focused narrative review and the tactile-visual decoupling hypothesis.

Robotic mitral valve repair has expanded rapidly, yet its learning curve is reported inconsistently and its determinants remain poorly understood. This focused narrative review, informed by a targeted scoping search, surveys the robotic and minimally invasive cardiac learning-curve literature and finds that the estimated learning phase depends on the chosen metric: operative-time analyses commonly place the plateau within the low tens to about fifty cases, whereas risk-adjusted clinical-outcome models extend it beyond ninety. A recent two-centre study reported operative-time cumulative-sum plateaus of robotic mitral repair at 16 versus 32 cases in the centre transitioning from mini-thoracotomy minimally invasive mitral valve surgery (MT-MIMVS) versus directly from sternotomy; the faster centre, however, also began faster and differed in repair technique, case-mix and proctoring; the comparison, resting on two single-surgeon programmes, is an observed association rather than causal evidence. Within the evidence identified, none quantified prior minimally invasive experience as a moderator of the robotic curve, leaving a specific, testable gap. We propose a neurocognitive framework - the tactile-visual decoupling hypothesis - that arranges the three principal mitral approaches along a coupling spectrum, with MT-MIMVS occupying a transitional zone in which cortical visuo-tactile remapping may be partially established before the near-complete decoupling of the robotic console. Drawing on sensory-substitution, haptic-feedback and cerebellar internal-model evidence, we derive predictions across neuroimaging, dose-response and error-profile domains designed to distinguish a specific visuo-tactile mechanism from the institutional, technical and volume confounders that currently accompany the observation, and outline the study designs required to test them.