Optimization of Vessel Orientation for Robotic Coronary Artery Bypass Grafting
AbstractThe availability of telemanipulation robots has not yet resulted in the emergence of a reliable endoscopic coronary bypass procedure. A major challenge in performing a closed-chest coronary operation is creating a high-quality anastomosis in a reasonable period of time. In this experimental study, the impact of distal vessel orientation on the speed and accuracy of anastomosis was quantifed. We found that vessel orientation and the relative angle of the surgical plane influence anastomosis speed, the trauma to the vessel, the accuracy of stitch placement, and the eventual achievement of hemostasis. Our results suggest that the speed and accuracy of a robotically performed anastomosis of a vessel graft to a coronary artery can be improved by making small changes in vessel orientation. Vessels should be positioned between the horizontal and diagonal orientation and inclined between the horizontal and +45°. Because the 6-o'clock stitch is particularly challenging, surgeons may benefit from an orientation that moves the heel or the toe of the anastomosis away from this critical position.
Boyd WD, Rayman R, Desai ND, et al. 2000. Closed-chest coronary artery bypass grafting on the beating heart with the use of a computer-enhanced surgical robotic system. J Thorac Cardiovasc Surg 120:807-9.nDuhaylongsod FG. 2000. Minimally invasive cardiac surgery defined. Arch Surg 135:296-301.nKappert U, Cichon R, Schneider J, et al. 2000. Closed-chest coronary artery surgery on the beating heart with the use of a robotic system. J Thorac Cardiovasc Surg 120:809-11.nReichenspurner H, Boehm D, Gulbins H, et al. 1999. Robotically assisted endoscopic coronary artery bypass procedures without cardiopulmonary bypass. J Thorac Cardiovasc Surg 118:960-1.nReichenspurner H, Damiano R, Mack M, et al. 1999. Use of the voice-controlled and computer-assisted surgical system ZEUS for endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg 118:11-6.nTalwalkar NG, Cooley DA. 1998. Minimally invasive coronary artery bypass grafting: a review. Cardiol Rev 6:345-9.n
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