Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery

The influence of patient thoracic anatomy on operative times in robotic total endoscopic coronary artery bypass (TECAB) has not been well described. The aim of this study was to determine whether patient anatomy correlates with intraoperative time required to complete various procedural steps and overall operative time in TECAB.

Preoperative multislice computed tomographic scans of the chest from 107 consecutive patients who underwent single-vessel TECAB were reviewed to measure a series of thoracic dimensions and relations. Measurements were correlated with time to complete various intraoperative procedural tasks as well as overall operative time.

There was a significant correlation between left internal mammary artery (LIMA) harvest time and depth of subcutaneous tissue at the level of the nipple (r = 0.24, P = 0.018). Pericardial fat pad thickness was associated with longer resection times (r = 0.266, P = 0.008). LIMA to left anterior descending artery anastomotic time was inversely correlated with the distance from the left heart border to the chest wall (r = -0.241, P = 0.016). Total operative time was also inversely correlated with this distance (r = -0.275, P = 0.005).

Anatomical measurements made on preoperative computed tomography in patients undergoing robotic TECAB can predict time requirements for various procedural steps. A shorter distance between the chest wall and the heart predicts longer anastomotic and total operative times. This information could assist the TECAB surgeon with surgical planning and help guide the TECAB trainee in patient selection.