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Related Experiment Videos

Robotic totally endoscopic coronary artery bypass: program development and learning curve issues.

J Bonatti1, T Schachner, O Bernecker

  • 1Innsbruck University Hospital, Department of Cardiac Surgery, Austria. johanes.o.obonatti@uibk.ac.at

The Journal of Thoracic and Cardiovascular Surgery
|February 6, 2004
PubMed
Summary

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Introducing robotic totally endoscopic coronary artery bypass grafting (TECAB) is feasible with a stepwise approach. While steep learning curves exist for robotic procedures, TECAB can be safely implemented without increased mortality.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Implementing new cardiac surgical procedures involves learning curves and potential risks.
  • Robotic totally endoscopic coronary artery bypass grafting (TECAB) is an innovative technique.
  • A stepwise, modular approach is proposed for safe TECAB introduction.

Purpose of the Study:

  • To demonstrate the safe implementation of robotic TECAB.
  • To evaluate the learning curve associated with robotic TECAB procedures.
  • To assess the safety and outcomes of a stepwise TECAB program.

Main Methods:

  • 50 robotic procedures were performed using the da Vinci system between June 2001 and December 2002.
  • Procedures included stepwise modules: robotic LITA harvesting, robotic anastomoses, and full robotic TECAB.

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  • Patients underwent conventional CABG, MIDCAB, or OPCAB post-harvesting, or full TECAB on an arrested heart.

    • Main Results:

    • Significant learning curves were observed for LITA takedown time and total operative time in TECAB.
    • The conversion rate for full TECAB was 2/15.
    • Intensive care unit stay correlated with total operative time; no hospital mortality occurred.

    Conclusions:

    • Robotic TECAB can be safely integrated into cardiac surgery programs.
    • Steep learning curves are noted for robotic LITA harvesting and TECAB performance.
    • Extended operative times may lead to longer ICU stays but not increased mortality.