Total endoscopic computer enhanced coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Coronary artery bypass (CAB) surgery traditionally involves significant access trauma.
• Minimally invasive techniques aim to reduce surgical invasiveness.
• Computer-enhanced technology offers potential for advanced surgical approaches.

Purpose of the Study:

• To evaluate a total endoscopic approach for coronary artery bypass surgery using the da Vinci telemanipulation system.
• To assess the feasibility and outcomes of robotic-assisted internal thoracic artery (ITA) harvesting and anastomosis.
• To determine the safety and efficacy of total endoscopic coronary artery bypass (TECAB).

Main Methods:

• The da Vinci system was used in 66 patients with coronary artery disease.
• Group 1 (12 patients): ITA to left anterior descending artery (LAD) anastomosis performed remotely.
• Group 2 (32 patients): Endoscopic ITA dissection followed by conventional minimally invasive direct coronary artery bypass (MIDCAB).
• Group 3 (22 patients): Complete total endoscopic coronary artery bypass (TECAB) performed through 4 ports with Port-Access cardiopulmonary bypass.

Main Results:

• Remote anastomosis in Group 1 was time-consuming (17 min) with one leak.
• Successful ITA harvest in 96% of Group 2 patients (61 min), with a learning curve noted.
• TECAB completed in 82% of Group 3 patients (220-507 min), with conversions required in 4 patients.
• Postoperative and 3-month follow-up angiography showed patent grafts in all TECAB patients.

Conclusions:

• Endoscopic ITA harvesting and arterial anastomoses are safely achievable with the da Vinci system.
• Total endoscopic coronary artery bypass (TECAB) is possible on an arrested heart, yielding good functional results.
• A significant learning curve impacts operation times and conversion rates in early TECAB procedures.