Total Endoscopic Beating-Heart Coronary Artery Bypass Grafting using a New 3D Imaging System

Tomita, Shigeyuki; Watanabe, Go; Tabata, Shigeki; Nishida, Satoru

doi:10.1177/155698450600100504

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Two very small series (31 patients total) are published in the literature (63,64) (Table 5), one from Ulm/Germany another form Kanazwa/Japan (33,65). Both groups managed to perform this extremely difficult operation.…”

Section: Resultsmentioning

confidence: 99%

“…The harvesting is reported both in pedicled and skeletonized fashion. The literature commonly describes a version with 2D view and only one more recent paper reports on the use of 3D endoscopy (33). In one very early report a flexible gastroscope was taken for IMA harvesting (34).…”

Section: Surgical Techniquementioning

confidence: 99%

“…The graft to coronary anastomosis is usually performed through a minithoracotomy under direct vision on the beating heart with local target vessel stabilization and temporary coronary artery occlusion. (23,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), 87.6% of them were single LIMA to LAD grafts. The LIMA harvesting time averaged 47.5±7.8 min, and in the paper describing bilateral IMA harvesting the RIMA harvesting time was 54 minutes.…”

Section: Surgical Techniquementioning

confidence: 99%

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Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Bonatti¹,

Wallner²,

Crailsheim³

et al. 2021

J Thorac Dis

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During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra-and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

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Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Bonatti¹,

Wallner²,

Crailsheim³

et al. 2021

J Thorac Dis

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show abstract

“…A t present, minimal invasive direct coronary artery bypass grafting (MIDCAB) is the least invasive nonrobotic (nr) surgical approach to revascularize the left anterior descending coronary artery (LAD) with the left internal mammary artery (LIMA). The first and so far only reports about a nonrobotic total endoscopic approach were published between 1999 and 2006 by Watanabe et al 1,2 At the same time, several authors promoted the use of a telemanipulator ("robot") to revascularize coronary arteries endoscopically. 3,4 More than 15 years later, only few centers have reported larger series of total endoscopic coronary bypass grafting (TECAB) with the da Vinci telemanipulator (Intuitive Surgical, Sunnyvale, CA USA).…”

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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“…N onrobotic total endoscopic coronary bypass grafting (nrTE-CAB), in theory, combines cost-effectiveness and superior long-term results with minimal cosmetic and functional disturbance. More than a decade ago, surgeons have reported first experimental 1Y5 and clinical 6,7 experience with this approach, but the highly demanding dexterity, the lack of suitable instruments, and suboptimal vision with two-dimensional camera systems deemed a routine clinical application impossible.…”

mentioning

confidence: 99%

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

Gorki

Patel

Liewald

et al. 2012

Innovations�(Phila)

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Objective Nonrobotic total endoscopic coronary bypass grafting is commonly considered as technically too difficult. After endoscopic practicing in a simple box model, we questioned this statement in a more sophisticated training model. Methods In a handmade chest model containing a mechanically actuated porcine heart, anastomoses between homologous vein and shunted anterior coronary artery were performed using Prolene 7–0 sutures or U-clips in 20 anastomoses each. Commercially available endoscopic instruments and exclusive two-dimensional endoscopic vision were used. As quality control, the procedures were recorded, flow was measured, indocyanine green dye angiograms were performed, vinylpolysiloxane endocasts were produced, and finally the anastomoses were assessed from the endothelial side. Three-dimensional computed tomographic reconstruction was explored for cast measuring. Results All anastomoses were completed successfully in a time of 51 ± 14 minutes (Prolene) and 48 ± 10 minutes (U-clips). Despite suboptimal equipment, a reproducible sequence of the procedure was established and documented. Improving surgical performance was reflected in a reduction in anastomotic leakage and time requirement. The quality assessment protocol showed a learning curve and problems itself, which are briefly discussed. Conclusions A beating heart model is an adamant requirement of training for the technically demanding procedure of nonrobotic total endoscopic coronary bypass grafting. Refinement of the model and quality assessment as well as expansion of training to other regions of the heart should prepare for a cost-effective, broad-based clinical application of nonrobotic endoscopic techniques in coronary surgery. Available high-definition three-dimensional vision systems and the development of appropriate (articulating) instruments will make the procedure safer and quicker and will cut the learning curve.

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Total Endoscopic Beating-Heart Coronary Artery Bypass Grafting using a New 3D Imaging System

Cited by 6 publications

References 10 publications

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

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

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