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Robotically assisted endoscopic transmyocardial laser revascularization.

Hironori Izutani1, Inderjit S Gill, Oleg Svanidze

  • 1Deparment of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44109, USA.

The Canadian Journal of Cardiology
|July 22, 2004
PubMed
Summary
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Robotically assisted endoscopic transmyocardial laser revascularization (TMR) is feasible in pigs. This minimally invasive approach successfully created transmural channels, offering potential benefits over open-chest surgery for angina treatment.

Area of Science:

  • Minimally invasive cardiac surgery
  • Robotic surgery
  • Laser technology in medicine

Background:

  • Transmyocardial laser revascularization (TMR) via thoracotomy is approved for angina in inoperable patients.
  • Its use as a standalone procedure is limited.
  • Minimally invasive alternatives are sought to reduce perioperative morbidity.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of robotically assisted endoscopic TMR.
  • To utilize the Zeus robotic surgical system and an excimer TMR system.
  • To test the procedure in a porcine model.

Main Methods:

  • Five pigs (20-40 kg) underwent the procedure.
  • A 10 mm endoscope and two 5 mm instrument ports were introduced into the left hemithorax.

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  • Zeus instruments guided a 1.4 mm TMR probe for channel creation on the left ventricle.

    • Main Results:

    • Mean procedure time was 5.0 minutes, creating an average of 10 transmural channels.
    • All pigs tolerated the procedure without complications.
    • Histological examination confirmed successful creation of transmural channels.

    Conclusions:

    • Robotically assisted endoscopic TMR is feasible in a porcine model.
    • The technique successfully created transmural laser channels in the left ventricle.
    • This approach may reduce perioperative morbidity and improve recovery compared to open-chest surgery.