Closed chest totally endoscopic coronary artery bypass surgery: Fantasy or reality?
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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.
- Calafiore AM, Giammarco GD, Teodori G, et al.: Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg 1996, 61:1658-1665. CrossRef
- Cremer J, Strüber M, Wittwer T, et al.: Minimally invasive direct voronary artery bypass (MIDCAB) to anterior coronary vessels on the beating heart. Ann Thorac Surg 1997, 63:79–83. CrossRef
- Gulielmos V, Knaut M, Cichon R, et al.: Minimally invasive surgical treatment of coronary artery multivessel disease. Ann Thorac Surg 1998, 66:1018–1021. CrossRef
- Gulielmos V, Brandt M, Knaut M, et al.: The Dresden approach for complete multivessel revascularization. Ann Thorac Surg 1999, 68:1502–1505. In a prospective clinical trial, a group of patients receiving less invasive surgical procedure, including minithoracotomy in combination with cardiopulmonary bypass (group 1), was compared with a group of patients receiving conventional bypass surgery (group 2) for the treatment of coronary artery disease. CrossRef
- Reichenspurner H, Gulielmos V, Daniel WG, Schueler S: Minimally invasive coronary artery bypass surgery (CABS) with the safety of cardiopulmonary bypass and cardioplegic arrest. N Engl J Med 1997, 336:67–68. CrossRef
- Subramanian VA, et al.: Transabdominal minimally invasive direct coronary artery by-pass grafting (MIDCAB). Eur J Cardiothorac Surg 2000, 17:485–487. A new “transabdominal approach” for multiple coronary artery bypass grafting is presented. CrossRef
- Subramanian VA, et al.: Minimally invasive direct coronary artery bypass grafting: two-year clinical experience. Ann Thorac Surg 1997, 64:1648–1653. CrossRef
- Jansen E, Gruendemann P, Borst C: Less invasive off pump CABG using a suction device for immobilization: the octopus method. Eur J Cardiothorac Surg 1997, 12:406–412. CrossRef
- Kappert U, Gulielmos V, Knaut M, et al.: The application of the octopus stabilizing system for the treatment of high risk patients with coronary artery disease. Eur J Cardiothorac Surg 1999, (suppl 2):7–9. Patients with single-vessel to multivessel disease and serious risk factors for cardiopulmonary bypass can be safely treated by OPCAB surgery.
- Loulmet D, Carpentier A, d'Attelis N, et al.: First endoscopic coronary artery bypass grafting using computer assisted instruments. J Thorac Cardiovasc Surg 1999, 118:4–10. CrossRef
- Falk V, Diegeler A, Walther T, et al.: Total endoscopic coronary artery bypass grafting. Eur J Cardiothorac Surg 2000, 17:38–45. The paper shows that endoscopic ITA harvesting and performing of arterial anastomoses can be safely performed with the da Vinci system, that TECAB is possible on the arrested heart with good functional results. A substantial learning curve has to be overcome which is reflected in long operation times and an initial significant conversion rate. CrossRef
- Kappert U, Cichon R, Schneider J, et al.: Closed chest coronary artery surgery on the beating heart using a robotic system. J Thorac Cardiovasc Surg 2000, in press. This paper presents the feasibility of an closed chest coronary artery bypass grafting on the beating heart using wrist enhanced instrumentation.
- Kappert U, Cichon R, Schneider J, et al.: Closed chest bilateral mammary artery grafting in double vessel coronary artery disease. Ann Tho-rac Surg 2000, in press. The demonstrated case shows that a closed chest bilateral internal mammary artery bypass grafting is possible.
- Closed chest totally endoscopic coronary artery bypass surgery: Fantasy or reality?
Current Cardiology Reports
Volume 2, Issue 6 , pp 558-563
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- 1. Department of Cardiac Surgery, Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307, Dresden, Germany
- 2. Department of Anesthesiology, Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307, Dresden, Germany