Closed chest totally endoscopic coronary artery bypass surgery: Fantasy or reality?
- 51 Downloads
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.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 4.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.PubMedCrossRefGoogle Scholar
- 9.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.Google Scholar
- 11.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.PubMedCrossRefGoogle Scholar
- 12.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.Google Scholar
- 13.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.Google Scholar