Abstrakt Kardiochirurgie Červenec 2009

“Invited Commentary.”

Bergsland, J. (2009).

Annals of Thoracic Surgery 88(2): 527-528.


Refers to:Training Surgeons to Perform Robotically Assisted Totally Endoscopic Coronary Surgery




“Robotic hybrid procedure and triple-vessel disease.”

Jansens, J. L., P. De Croly, et al. (2009).

Journal of Cardiac Surgery 24(4): 449-450.


A 56-year old man presented with increasing angina pectoris. Coronary angiogram showed a triple-vessel disease, with significant lesions on the main stem, on an obtuse marginal branch of the circumflex coronary artery (Cx), on the right coronary artery (RCA), and a proximal occlusion of the left anterior descending artery (LAD). A hybrid procedure was decided, with a beating heart totally endoscopic double vessel coronary artery bypass grafting (Double BHTECAB) on the LAD and the Cx, with the use of a four-arm robotic device, and a stent placement into the RCA in a second step. Both procedures went uneventfully, and the patient is fully asymptomatic 15 months after the procedure. © 2009 Wiley Periodicals, Inc.




“Robot-assisted antegrade in-situ fenestrated stent grafting.”

Riga, C. V., C. D. Bicknell, et al. (2009).

CardioVascular and Interventional Radiology 32(3): 522-524.


To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 Ã- 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure. © 2008 Springer Science+Business Media, LLC.




“Training Surgeons to Perform Robotically Assisted Totally Endoscopic Coronary Surgery.”

Schachner, T., N. Bonaros, et al. (2009).

Annals of Thoracic Surgery 88(2): 523-527.


Background: Robotic totally endoscopic coronary bypass (TECAB) surgery was developed during the past decade, and younger surgeons need to be trained in this new modality. This study assessed the learning curves and independent TECAB performance of 2 junior surgeons undergoing TECAB training. Methods: Two surgeons in training performed portions of 44 of 239 robotic TECAB operations, including left (LIMA) and right interior mammary artery (RIMA) harvesting, lipectomy, pericardiotomy, and IMA to left anterior descending coronary artery (LAD) anastomotic suturing. Results: The procedure portions performed faster by the senior surgeon vs trainees were, in minutes (range), lipectomy, 5 (2 to 18) vs 10 (5 to 21; p < 0.001); pericardiotomy, 5 (1 to 21) vs 7 (3 to 16; p = 0.001); RIMA takedown, 35 (25 to 48) vs 49 (40 to 55; p = 0.034); and LIMA to LAD anastomosis, 26 (12 to 100) vs 34 (24 to 67; p = 0.043). After assuming senior roles in the robotic cardiac surgery program, the 2 trained surgeons performed 14 TECABs (LIMA to LAD) without the senior surgeon. Lipectomy took 5 (3 to 8) minutes; pericardiotomy, 5 (2 to 10) minutes; LIMA takedown, 43 (27 to 70) minutes; LIMA to LAD anastomosis, 24 (15 to 60) minutes, cardiopulmonary bypass time, 73 (40 to 126) minutes; and aortic endo-occlusion time, 53 (0 to 83) minutes. No hospital deaths occurred. Conclusions: TECAB can be well taught with a stepwise training program involving portions of the procedure performed by trainees. With such an approach, independent performance after training can be within adequate time limits and yields seemingly acceptable results. © 2009 The Society of Thoracic Surgeons.