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Anatomy-based eligibility measure for robotic-assisted bypass surgery
Abelardo Escoto1, Ana Luisa Trejos, Rajni V Patel
1From the *Canadian Surgical Technologies & Advanced Robotics (CSTAR), Lawson Health Research Institute; and †Department of Electrical and Computer Engineering, ‡Department of Surgery, §Department of Medical Imaging, and ∥Division of Cardiac Surgery, Department of Surgery, The University of Western Ontario, London, Ontario, Canada.
Objective:
Robotic-assisted endoscopic single-vessel small thoracotomy allows clinicians to perform coronary artery bypass grafting surgery in a minimally invasive manner using the da Vinci Surgical System. Not all patients are suitable for this technique, and the lack of an appropriate method for patient eligibility avoids completion of the procedure robotically. The objective of this study was to develop a patient eligibility method based on the anatomy of the chest of the patient.
Methods:
Preoperative computed tomography thorax scans of 110 patients were analyzed. Two-dimensional measurements taken on the axial images were used with the goal of finding a relation between the anatomy of the patient and the completion of the procedure robotically.
Results:
Patients with a distance from the left anterior descending coronary artery to the anterior chest wall of smaller than 15 mm have a 20% probability of requiring conversion of the procedure to open surgery. This probability increases if the chest of the patient is very elliptical, having an anterior-posterior dimension of less than 45% of the transverse dimension.
Conclusions:
The smaller the distance is from the left anterior descending artery to the anterior chest wall, the lower the chances are of completing the procedure robotically.
Insights
A new method using chest anatomy can predict suitability for robotic-assisted coronary artery bypass grafting. Shorter distances between the left anterior descending artery and chest wall decrease the likelihood of successful robotic completion.
Area of Science:
- Cardiovascular Surgery
- Medical Robotics
- Thoracic Surgery
Background:
- Robotic-assisted surgery offers minimally invasive options for coronary artery bypass grafting (CABG).
- Patient selection is crucial for successful robotic CABG, but a standardized method is lacking.
- Current limitations hinder the robotic completion rate for eligible patients.
Purpose of the Study:
- To develop a patient eligibility assessment method for robotic-assisted CABG.
- To identify anatomical predictors of successful robotic completion.
- To improve patient selection for minimally invasive cardiac surgery.
Main Methods:
- Analysis of preoperative computed tomography (CT) thorax scans from 110 patients.
- Utilizing 2D measurements from axial CT images.
- Correlating patient chest anatomy with robotic procedure completion.
Main Results:
- A distance <15 mm from the left anterior descending (LAD) coronary artery to the anterior chest wall correlates with a 20% probability of conversion to open surgery.
- Elliptical chest shapes (anterior-posterior dimension <45% of transverse dimension) further increase the risk of conversion.
- These anatomical factors significantly impact the feasibility of robotic CABG.
Conclusions:
- Closer proximity of the LAD artery to the chest wall reduces the success rate of robotic CABG.
- Chest wall geometry is a key determinant for robotic cardiac surgery eligibility.
- This anatomical assessment method can guide patient selection for robotic CABG.
