Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Abstract

ObjectiveTo follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. Summary Background DataRecently there has been an interest in using robotics and computers to enhance the surgeon's ability to perform endoscopic cardiac surgery. This interest has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instruments, it has not been possible to perform coronary surgery. MethodsNineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to construct the LITA-LAD anastomosis. All other required grafts were completed by conventional techniques. ResultsSeventeen LITA-LAD grafts (89%) had adequate intraoperative flow. The mean LITA-LAD graft flow was 38.5 Ϯ 5 mL/ min. At 8 weeks, LITA-LAD grafts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 Ϯ 4.2 months, all patients were NYHA class I and there were no adverse cardiac events. ConclusionsThe results from the first prospective clinical trial of robotically assisted endoscopic coronary bypass surgery in the United States showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabling technology allowing the performance of endoscopic coronary anastomoses.During the past 10 years, surgeons have begun to explore strategies to decrease the invasiveness of cardiac surgery. Great strides have been made in the development of beating heart surgery, which eliminates cardiopulmonary bypass. 1 Techniques also have been developed to decrease the size of the incision, and some procedures can now be performed through small thoracotomies 2 and limited sternotomies. The next step in the evolution of minimally invasive cardiac surgery would be the development of a completely endoscopic procedure. The explosion of arthroscopic and laparoscopic techniques during the past several decades has revolutionized orthopedic and general surgery. However, endoscopic techniques have had little impact on microsurgical disciples, such as cardiac surgery. There are several reasons for this shortcoming. Traditional endoscopic instruments are not well suited for microsurgery 4 because of their length and the fulcrum effect. The length of the instruments magnifies even the smallest surgical tremor, making microsurgery difficult

A systematic review on robotic coronary artery bypass graft surgery

“…One study provided separate data for both the TECAB offpump and robotic MIDCAB groups, and was included for analysis in both groups (10). Eighteen additional studies reported on a mixture of different surgical techniques (18,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53). A summary of the study selection process is presented in the PRISMA chart in Figure 1, and a summary of study characteristics is presented in Table 1.…”

“…Twenty-one studies were excluded from the final analysis due to a mixed dataset for different surgical techniques (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) or use of cardiopulmonary bypass (36)(37)(38)(39)(40)(41), or use of an outdated robotic system other than the da Vinci system (18,34,35). Of the patients who were included for statistical analysis in the selected studies on off-pump TECAB, on-pump TECAB and robotic MIDCAB, the mean age ranged from 58 to 67, and 51-88% of patients were male.…”

History of robotic surgery and its place in modern coloproctology: literature review

“…К тому же отсутствие тактиль-ной чувствительности тканей делает любую манипуляцию в значительной степени зависи-мой от качества визуализации. Наконец, физи-ологический тремор руки хирурга легко пере-дается через длинный жесткий инструмент на его рабочую часть, что создает значительные трудности при выполнении ряда прецизион-ных манипуляций [10]. Мотивация разработки хирургических роботов коренится в желании преодолеть ограничения существующих лапа-роскопических технологий и расширить преи-мущества малоинвазивной хирургии.…”

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“…A recent clinical study of 41 patients who underwent TECAB for isolated LAD lesions found a 92.7% 5 year survival and 87.2% freedom from re-intervention (90). Immediate and midterm angiographic patencies have been equivalent to standard CABG, but with unparalleled patient satisfaction (91)(92)(93), further advocating increased focus on advancing techniques of TECAB.…”