[Telemanipulatory application of a magnetic coupler on the beating heart with the daVinci surgical system]

The construction of a coronary anastomosis on the beating heart under totally endoscopic conditions is technically demanding. In this study the potential benefits of an endoscopic magnetic vascular coupler (MVP, Ventrica, Inc, Fremont, CA) designed to facilitate construction of a coronary anastomosis with the help of the daVinci telemanipulator (Intuitive Surgical Inc., Sunnyvale, CA) were evaluated in a totally endoscopic coronary arterial bypass (TECAB) operation on the beating heart in eight dogs. The telemanipulated instruments were used to guide and place the endoscopic MVP-application platform (prototype). All animals underwent angiography, and gross inspection of the anastomotic site was done after excision of the hearts. The procedure was accomplished in 169 minutes (155-190). With the exception of one premature deployment, all MVP-anastomoses were accomplished in 3 minutes (1-28). The following adverse events were encountered: Bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage upon reperfusion requiring repair stitches (2), anastomotic occlusion due to a thrombus (1). All but one animal that died on reperfusion despite a patent graft and anastomosis, survived the procedure. Overall patency was 7 out of 8. The combination of telemanipulator technology allowing increased manipulation dexterity in a total endoscopic environment and the effective and time saving magnetic technique for anastomotic coupling has the potential to facilitate TECAB on the beating heart.