Robot-Assisted Computer Enhanced Closed-Chest Coronary Surgery: Preliminary Experience Using a Harmonic Scalpel® and ZEUS™

Abstract

Background: Successful endoscopic harvesting of arterial conduits is critical to the performance of totally endoscopic bypass grafting. Recent success with computer-enhanced robotic systems in the performance of endoscopic single vessel coronary artery bypass (ENDOCAB) has paved the way for developing techniques for multivessel ENDOCAB. The Harmonic Scalpel^® (Ethicon Endo-Surgery, Cincinnati, OH) has previously demonstrated versatility and efficacy in manual endoscopic internal thoracic artery (ITA) harvesting. This study was undertaken to determine the feasibility of adapting this technology to a robotic telemanipulation system and its safety and efficacy in telerobotic ITA harvesting.

Methods: The Harmonic Scalpel^® was adapted to the ZEUS™ robotic surgical system (Computer Motion, Goleta, CA) and used to harvest the ITA in 19 patients undergoing multivessel off-pump coronary artery bypass (OPCAB) surgery. With the left lung collapsed, the ITA was harvested in all patients with CO₂ insufflation through three 5 mm ports in the left chest. Postoperative angiography and transthoracic Doppler studies were performed in all patients.

Results: There were no ITA injuries and patients tolerated insufflation without hemodynamic compromise. Side branches were controlled easily without bleeding. Average ITA harvest time was 65 ± 21 minutes. All vessels were patent after harvesting and demonstrated no angiographic evidence of injury.

Conclusions: This paper demonstrates a technique by which the Harmonic Scalpel^® can be readily adapted to the ZEUS™ robotic telemanipulation system. Using this system, ITA’s can be safely harvested totally endoscopically within a reasonable time frame for patients undergoing ENDOCAB.