This new robotic-enhanced surgical technique promotes an optimistic way of thinking about the further development of this procedure and its application in patients suffering from single-vessel CAD.
Background-The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team. Methods and Results-Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64Ϯ10.5 years, left ventricular ejection fraction 68Ϯ12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (nϭ156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (nϭ37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (nϭ8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration.
Conclusions-The
Background
The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team.
Methods and Results
Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64±10.5 years, left ventricular ejection fraction 68±12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (n=156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (n=37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (n=8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration.
Conclusions
The introduction of this new surgical tool enables the development of new endoscopic procedures. Our results gained during the development of robotic enhanced CABG motivate us to establish a set standard for the totally endoscopic treatment of patients with 1-vessel coronary artery disease.
With the introduction of the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) into minimally invasive cardiac surgery, the outlook of performing coronary artery bypass operations "closed chest" became a reality. Between May 1999 and July 2000 this wrist-enhanced instrumentation was used in 143 patients (107 men, 36 women, median age 63 10.3 y). Thirteen patients suffering from coronary artery disease (CAD) were treated as totally endoscopic coronary artery bypass (TECAB), 79 patients underwent a minimally invasive direct coronary artery bypass procedure, and 35 patients were treated using the robotic-enhanced Dresden Technique. Preoperative survival was 100%. All patients in the TECAB group were operated upon via a three- or four-point stab incision using the da Vinci robot for internal mammary artery takedown and for performance of anastomoses. These new robotic-enhanced surgical techniques promote an optimistic way of thinking about the further development of these procedures and its application in patients suffering from CAD.
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