Totally endoscopic robotic coronary artery bypass surgery

Abstract

TECAB surgery is a feasible alternative to open coronary artery bypass surgery in selected patient populations. Appropriate patient selection, team training, and stepwise application of the procedure are crucial. TECAB is associated with a unique set of challenges, requiring a skilled operative team. As robotic technology and surgical expertise evolve, this technology will find wider application in an increasing high-risk patient population that will require the support of a skilled anesthesiology team.

Robotic coronary artery surgery: Outcomes and pitfalls

“…It provides the surgeon with a threedimensional (3D), high resolution view of the operative field, wherein the surgeon is virtually immersed in the intrathoracic cavity. 5 RACAB is described as the robotic harvesting of LIMA along with a LIMA-LAD anastomosis. 11 An advanced version of the MIDCAB and RACAB, is TECAB, which has been developed in the last decade.…”

“…These include arrested-heart TECAB, beating heart TECAB with the use of CPB (on-pump) and beating heart TECAB without the use of CPB (off-pump). 5 The first TECAB RAVIKUMAR ET AL.…”

“…37 However, the benefits of TECAB in terms of shorter hospital stay, smaller incision, and improved quality of life outweigh these issues and reduce postoperative costs as compared with traditional approaches. 5,32 There is also reduced benefit observed when robotic assistance These issues need to be considered with utmost importance, however, with essential modifications in anastomosis techniques and increased experience of the surgical team, they can be overcome.…”

“…39 safety. 20 Thus, the stepwise training program suggested by Deshpande et al 5 will strive to implement strategies for the whole medical team to coherently develop their skills respectively when using RA-CAB, thus collectively serving the purpose of minimally invasive CABG and potentially decreasing the varied operating times as also noted by Bonaros et al 40 The authors agreed that earlier integration of robotic surgical simulation is a beneficial idea in the education of surgical trainees so that their experience can be acquired at an earlier stage of their career. Perhaps even implementing elements of this within the undergraduate medical degree curriculum could enhance theoretical and practical understanding of the procedures that prospective surgeons and future medics will be already aware of when entering their profession and subsequent speciality training.…”

“…Various engineering and technological advancements in this arena enabled CABG to become minimally invasive as it was possible to conduct the procedure through total endoscopy CABG (TECAB). Over the last 20 years, various specialized medical centers have implemented robot‐assisted CABG (RACAB) as a highly efficient method of revascularizing the coronary circulation due to proven benefits such as minimal surgical trauma, less incisions and faster recovery time 5 . Nonetheless, not only does it come at a high cost; certain drawbacks exist in this field revolving around the experience required in robotics in comparison with conventional style procedure, which can only be acquired and developed in time 6 .…”