A Step toward Nonrobotic Total Endoscopic Coronary Bypass Grafting: 40 Coronary Anastomoses in a Biomechanical Beating Heart Model

Gorki, Hagen; Patel, Nirav; Liewald, Christian; Wildhirt, Stephen M.; Subramanian, Valavanur A.; Liebold, Andreas

doi:10.1097/imi.0b013e31827cd52b

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…To the best of our knowledge, commercially available beating heart and chest models, whichever totally artificial or tissue based, were not specifically designed for endoscopic approaches. Gorki et al 13,14 described that their wet-lab training model with porcine heart in a handmade mock thorax was effective to learn the nrTECAB technique; however, there were access limitations for learners who wished to start the TECAB training because of the limitation in obtaining the porcine heart and the complexity of the training system itself. Thus, we thought FIGURE 5.…”

Section: Discussionmentioning

confidence: 99%

Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis

Ujihira

Yamada

2017

Innovations�(Phila)

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Objective We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis. Methods All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the “nonbeating” version, and the third stage is the “beating” version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves. Results The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage. Conclusions Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.

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Section: Discussionmentioning

confidence: 99%

Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis

Ujihira

Yamada

2017

Innovations�(Phila)

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“…The anastomosis was performed using a shortened (approximately 12 cm) double-needled running suture (7-0 Everpoint; Ethicon) starting at the opposite site as described previously. 10 After completion of the anastomosis, Doppler transit time flow measurement (VeriQ; Medistim, Oslo, Norway) with a flexible probe or laser fluorescence imaging (Pinpoint; Novadaq, Mississauga, ON Canada) were performed if suitable and available to confirm adequate flow. The balloon was deflated and the heart started to beat spontaneously, in three cases after external defibrillation (instruments removed).…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Here, the telemanipulator is used for endoscopic harvesting of the LIMA avoiding traumatic asymmetric rib spreading followed by manual performance of anastomoses under direct vision via a minithoracotomy. 8,9 After extensive training in a biomechanical model, 10 in a porcine model 11 and in human body donors, a prospective clinical proof-of-concept study for nrTECAB was initiated. The revascularization LIMA to LAD was planned exclusively under endoscopic vision without telemanipulator.…”

mentioning

confidence: 99%

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

Gorki

Sabău

et al. 2018

Innovations�(Phila)

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Objective At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator (“robot”). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach. Methods Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases. Results In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting). Conclusions With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.

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“…Anastomosis was performed starting at the opposite side of the coronary artery, suturing one end toward the heel then the other end toward the distal angle and continuing the anastomosis by suturing from the heel, then from the toe (or vice versa) of the anastomosis on the side of the surgical access. 5 After shunt removal and completion of the anastomosis, both suture ends were tied. Then the bulldog clamp was removed from the IMA.…”

Section: Anastomosismentioning

confidence: 99%

“…4 Promising results of endoscopically sutured coronary anastomoses in a biomechanical model were reported previously. 5 After approval by the regional authorities (Thuringian State Office of Consumer Protection, Germany, registry number 08-007/13), we established arrested heart nrTECAB in an animal model by grafting an internal mammary artery (IMA) to the left anterior descending coronary artery (LAD).…”

Section: Introductionmentioning

confidence: 99%