“On-pump beating-heart with axillary artery perfusion: a solution for robotic totally endoscopic coronary artery bypass grafting?”
Heart Surg Forum 12(3): E131-3.
Robotic totally endoscopic coronary artery bypass grafting (TECAB) can be performed on the arrested heart or on the beating heart without heart-lung machine support. In high-risk patients or in patients where technical difficulties are expected with a complete off-pump approach, a beating heart concept with heart-lung machine support can be an important option. Femoral arterial cannulation is associated with additional risk of retrograde cerebral embolization, and axillary cannulation is an accepted method in aortic surgery. We describe a case where an axillary artery cannulation method was used for the first time in TECAB performed with the da Vinci telemanipulation system.
“Robotically enhanced coronary artery bypass grafting: the feasibility and clinical outcome of 196 procedures.”
Int J Med Robot 5(2): 170-7.
BACKGROUND: The aim of this study was to assess the feasibility of robotically enhanced myocardial revascularization and to present the clinical outcome of 196 patients. METHODS: All internal thoracic arteries were harvested with the aid of a robotic surgical system. While off-pump revascularization techniques were mostly used, peripheral cardiopulmonary bypass was needed in some cases with multivessel disease. RESULTS: A single (n = 118) or multivessel (n = 74) coronary revascularization was performed. Four patients had to be converted to median sternotomy. There was no operative mortality. Follow-up was complete in 88% (n = 169) patients. The rate of freedom from ischaemic symptoms was 98.2% at mean 22 +/- 3 months. Graft patency was 96.4% (81/84). CONCLUSIONS: By increasing surgical capabilities, robotically enhanced CABG in single or multivessel coronary disease was safe, effective and reasonable. It can be an alternative approach to percutaneous methods and conventional surgical techniques, or even used in acute coronary events.
“Case 3-2009 Robotically Assisted Cardiac Surgery.”
Journal of Cardiothoracic and Vascular Anesthesia 23(3): 407-416.
“Establishing the case for minimally invasive, robotic-assisted CABG in the treatment of multivessel coronary artery disease.”
Heart Surg Forum 12(3): E147-9.
The purpose of this review is to outline the most common objections about robotic coronary artery bypass graft (CABG), often expressed by cardiac surgeons, cardiologists, and administrators who have little direct knowledge of the procedure. The summarized objections include the high intraoperative costs of robotic versus traditional CABG, a prolonged and difficult learning curve for members of the surgical team, and concerns about compromising graft patency with this technique. Arguments for continued procedure development in robotically assisted CABG are provided.
“Robotically-assisted cardiac surgery.”
Interact Cardiovasc Thorac Surg.
Recognition of the significant advantages of minimizing surgical trauma has resulted in a substantial increase in the number of minimally invasive (MI) cardiac surgical procedures being performed. Synchronously, technological advances in optics, instrumentation and perfusion technology have facilitated routine totally endoscopic robotic cardiac surgery using the da Vinci(R) telemanipulation system (Intuitive Surgical Inc.). This technology has been applied to many cardiac surgical procedures, in particular, mitral valve repair (MVP) and totally endoscopic coronary artery bypass grafting (TECAB), allowing the surgeon to operate through 5 mm port sites rather than a traditional median sternotomy. In this rapidly evolving field, we review the clinical results of robotic cardiac surgery. Keywords: Surgical procedures; Minimally invasive; Thoracic surgery; Video-assisted; Robotics; Telemedicine/instrumentation.
“Poor left ventricular function is not a contraindication for robotic totally endoscopic coronary artery bypass grafting.”
Heart Surg Forum 12(3): E152-4.
Robotic technology has enabled performance of totally endoscopic coronary artery bypass grafting (TECABG). Published series on TECABG were primarily performed in low-risk patients, and little is known about the outcome after totally endoscopic coronary surgery in patients with severely impaired left ventricular function. We report successful endoscopic placement of a left internal mammary artery bypass graft to the left anterior descending artery using the daVinci robotic system in a patient with a severely reduced left ventricular ejection fraction.
“Totally endoscopic coronary artery bypass grafting is feasible in morbidly obese patients.”
Heart Surg Forum 12(3): E134-6.
Development of robotic technology has enabled totally endoscopic coronary artery bypass grafting (TECAB) procedures. With complete preservation of sternal and thoracic stability, this operation would be an interesting option for obese patients, who are known to be at higher risk for deep sternal wound infection. We describe a case of successful totally endoscopic left internal mammary artery to left anterior descending artery bypass grafting using the da Vinci telemanipulation system in a patient who was morbidly obese. The patient underwent a so called staged hybrid coronary intervention with percutaneous angioplasty and placement of a stent to the right coronary artery.