“Robotic-assisted surgical myotomy in a 27-year-old man with myocardial bridging of the left anterior descending coronary artery.”
Alimab, M. B., F. Vanden Eyndena, et al. (2010).
Interactive Cardiovascular and Thoracic Surgery 11(2): 185-187.
Myocardial bridging (MB) is a frequent condition usually considered benign but it may be associated with myocardial ischemia. When bridging is symptomatic, therapeutic options are numerous and in the absence of guidelines all options are conceivable. This is a case of a 27-year-old man who benefited from a new surgical approach: myotomy for MB of the left anterior descending coronary artery with the help of left robotic thoracoscopy. ©2010 Published by European Association for Cardio-Thoracic Surgery.
“Hybrid coronary revascularization: which patients? When? How?”
Bonatti, J., E. Lehr, et al. (2010).
Current Opinion in Cardiology 25(6): 568-574.
PURPOSE OF REVIEW: The aim of this review is to report on current indications and patient selection for hybrid coronary revascularization and to outline current techniques for a hybrid approach. RECENT FINDINGS: Hybrid coronary intervention is a revascularization strategy that combines surgical and catheter-based procedures for treatment of multivessel coronary artery disease. Most published studies report on application of this concept in patients with complex lesions of the left anterior descending artery and nonleft anterior descending lesions suited for percutaneous coronary intervention. Currently, the spectrum of surgical procedures in hybrid coronary revascularization ranges from left internal mammary artery bypass grafting via sternotomy and minithoracotomy to completely endoscopic robotic double vessel coronary artery bypass grafting. Percutaneous coronary intervention in hybrid procedures is performed as single or multiple coronary angioplasty with stenting using either bare metal or drug-eluting stents. Staged and simultaneous approaches can be applied. The latter are increasingly performed in the hybrid operating room. SUMMARY: Hybrid coronary intervention is an emerging interdisciplinary approach in the treatment of coronary artery disease and a potential viable alternative to open coronary bypass surgery or multivessel stenting.
“Robotic coronary artery bypass for aberrant right coronary artery stenosis.”
Chen, K. C., P. Teefy, et al. (2010).
Canadian Journal of Cardiology 26(8): 326-327.
Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient’s angina symptoms.
“Robotic coronary artery bypass grafting.”
Folliguet, T. A., A. Dibie, et al. (2010).
Journal of Robotic Surgery: 1-6.
Robotically assisted surgery enables coronary surgery to be performed totally or partially endoscopically. Using the Da Vinci robotic technology allows minimally invasive treatments. We report on our experience with coronary artery surgery in our department: patients requiring single or double vessel surgical revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. From April 2004 to May 2008, 55 consecutive patients were enrolled in the study, and were operated on by a single surgical team. Operative outcomes included operative time, estimated blood loss, transfusions, ventilation time, intensive care unit (ICU) and hospital length of stay. Average operative time was 270 ± 101 min with an estimated blood loss of 509 ± 328 ml, a postoperative ventilation time of 6 ± 12 h, ICU stay of 52 ± 23 h, and a hospital stay of 7 ± 3 days. Nine patients (16%) were converted to open techniques, and transfusion was required in four patients (7%). Follow-up was complete for all patients up to 1 year. There was one hospital death (1.7%) and two deaths at follow-up. Coronary anastomosis was controlled in 48 patients by either angiogram or computed tomography scan, revealing occlusion or anastomotic stenoses (>50%) in six patients. Overall permeability was 92%. Major adverse events occurred in 12 patients (21%). One-year survival was 96%. Our initial experience with robotically assisted coronary surgery is promising: it avoids sternotomy and with a methodical approach we were able to implement the procedure safely and effectively in our practice, combining minimal mortality with excellent survival. © 2010 Springer-Verlag London Ltd.
“Robotic Repair of Access-Related Aortic Injuries: Unexpected Complication of Robot-Assisted Prostatectomy.”
Gibson, B. and R. Abaza (2010).
Journal of Endourology.
Abstract Robot-assisted surgery is becoming more widespread, but despite adoption by most academic institutions, curricula for training residents in robotics have yet to be developed fully. Even after teaching surgeons have mastered robotic techniques, an inherent risk of avoidable injuries may persist as they seek to impart their knowledge of this relatively new surgical modality to trainees. Two cases of aortic injury during access for robot-assisted prostatectomy are described along with their successful robotic repair with root-cause analysis of the events. Robotic surgeons who are involved in training programs should be prepared to handle even major potential complications of robot-assisted surgery regardless of their own expertise or experience.
“Minimized extracorporeal circulation for the robotic totally endoscopic coronary artery bypass grafting hybrid procedure.”
Lehr, E. J., P. Odonkor, et al. (2010).
Canadian Journal of Cardiology 26(7).
Robotically assisted totally endoscopic coronary artery bypass grafting (TECAB) can be performed on the beating heart with cardiopulmonary bypass support in high-risk patients or patients for whom technical difficulties are expected with a complete off-pump approach. To minimize the inflammatory response and reduce the requirement for transfusion, minimized extracorporeal circulation is an attractive option for robotic TECAB procedures. The present report describes a case for which minimized extracorporeal circulation was used for the first time in TECAB performed using the da Vinci telemanipulation system. ©2010 Pulsus Group Inc. All rights reserved.
“Axillary-coronary sequential vein graft for total endoscopic triple coronary artery bypass.”
Lehr, E. J., D. Zimrin, et al. (2010).
Annals of Thoracic Surgery 90(5): e79-81.
We describe using an axillary-coronary vein graft for robotically assisted, total endoscopic coronary artery bypass grafting. After constructing the proximal vein anastomosis to the left axillary artery under direct vision, the graft was brought into the thorax through a thoracostomy in the second left intercostal space. Under cardiopulmonary bypass with cardioplegic arrest, the distal anastomoses were completed using da Vinci (Intuitive, Sunnyvale, CA) robotic instrumentation through small portholes. This procedure marks a significant advancement in robotic total endoscopic revascularization by increasing the range of targets available for the total endoscopic approach, thereby enlarging the patient population suitable for robotic revascularization.
“Is there a role for robotic totally endoscopic coronary artery bypass in HIV positive patients?”
van Wagenberg, F. S., E. J. Lehr, et al. (2010).
Int J Med Robot.
BACKGROUND: Performing cardiac surgery on HIV positive patients represents a significant risk of occupational exposure to surgeons and their support staff. In addition, the immunocompromized state of these patients may be a factor which could adversely influence the results. Totally endoscopic coronary artery bypass grafting (TECAB) in HIV patients has not been reported. METHODS: A male patient with HIV and Hepatitis C presented with three vessel coronary artery disease requiring surgical revascularization. Totally endoscopic coronary artery bypass grafting was performed. Using the da Vinci (R) surgical robot, the left and right internal mammary arteries were harvested and sutured to the second obtuse marginal branch and the left anterior descending artery respectively. RESULTS: The patient was discharged home on postoperative day six. At one month following the operation, the patient was asymptomatic and had returned to full activity without the need for sternal precautions. CONCLUSIONS: We describe the first case of completely endoscopic coronary surgery using the da Vinci (R) system in an HIV patient. Double internal mammary artery grafting to the left coronary artery system was carried out successfully. Copyright (c) 2010 John Wiley & Sons, Ltd.