Clinical Investigation: Endoscopic Coronary Artery Bypass Grafting with Robotic Assistance

Abstract

Background: The current study reviews clinical feasibility experiences evaluating safety and efficacy of using robotic assistance to create a left internal mammary artery to left anterior descending artery (LIMA-to-LAD) anastomosis.
Methods: Between August and November 1999, 9 patients (aged 54-73 years) underwent robotically assisted endoscopic coronary artery bypass grafting (E-CABG) after institutional review board approval and informed consent were obtained. The robotics were transthoracically introduced in the fifth and sixth intercostal spaces. The LIMA-to-LAD anastomoses were endoscopically constructed with robotic assistance, and patency was assessed by flow measurement.
Results: Each anastomosis was performed robotically, with-out necessity for intraoperative intervention with traditional techniques. Robotic anastomosis times averaged 29.05 min-utes. The robotic system added on average 41.28 minutes to the procedure. LIMA flows prior to anastomoses measured from 11.2 to 29.2 mL/min. LIMA flow measurements follow-ing anastomoses averaged 42.07 mL/min. There were no deaths or perioperative myocardial infarctions.
Conclusions: Although E-CABG is an exhaustive and technically demanding procedure, it is feasible for a computer-enhanced robotic telemanipulation system to safely and effec-tively provide substantial assistance to the surgeon complet-ing a thoracoscopic coronary anastomosis.