Totally Endoscopic Multivessel Coronary Artery Bypass Surgery Using the da Vinci Surgical System: A Feasibility Study on Cadaveric Models
Background: The aim of the study was to develop a totally endoscopic coronary artery bypass procedure for the treatment of multivessel disease (MVTECAB).
Methods: Procedure development was conducted on 6 human cadavers with the da Vinci Surgical System. For aortic clamping, a transthoracic aortic clamp was applied. The proximal anastomoses of vein grafts were created transthoracically with the Corlink automated anastomosis device. The target vessels on the heart were exposed with a modified endoscopically applicable Starfish vacuum device. In 1 cadaver, the endo-sling and endoscopic fan retractors were studied for exposure support.
Results: Harvesting of bilateral internal thoracic arteries was easily accomplished. Aortic clamping was easier from the right side. In the left-side approach, the proximal anastomoses were completed without leakage in all 3 cadavers. One incorrect deployment occurred, and the deployment needed to be redone. In the right-side approach, 1 proximal anastomosis was performed without leakage, and another needed to be repaired for incorrect deployment. The fan retractors either covered too much of the targeted area of the heart surface or did not provide good manipulation capabilities. The endo-sling enabled atraumatic exposure of the target vessels. The modified Starfish performed sufficiently for exposing target vessels. Problems were found with epicardial fat clogging the Starfish suction chamber and with bending of the suction tube neck, both of which resulted in a loss of tissue contact. Two of the cadavers approached from the left side were completely revascularized with 3 grafts, and 4 anastomoses were performed on the third cadaver. Triple-vessel revascularization was performed in the cadavers approached from the right side.
Conclusion: This study demonstrates the feasibility of performing an MVTECAB on the arrested heart with the da Vinci Surgical System. Further procedure development is necessary to optimize the synergistic effects of the technologies used and to introduce this operation into clinical practice.
Calafiore AM, Bar-El Y, Vitolla G, et al. 2001. Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta. J Thorac Cardiovasc Surg 121:854-8.nCichon R, Kappert U, Schneider J, et al. 2000. Robotic-enhanced arterial revascularization for multivessel coronary artery disease. Ann Thorac Surg 70:1060-2.nCichon R, Kapsalis A, Schneider J, et al. Totally endoscopic coronary artery anastomosis on a beating heart with application of the Coalescent Sutured-Clips. Pol Przegl Chir. In press.nDogan S, Aybeck T, Andreßen E, et al. 2002. Total endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovasc Surg 123:1125-31.nDogan S, Aybeck T, Westphal K, Mierdl S, Moritz A, Wimmer-Greinecker G. 2001. Computer-enhanced totally endoscopic sequential arterial coronary bypass. Ann Thorac Surg 72:610-1.nFalk V, Diegeler A, Walther T, Autschbach R, Mohr FW. 2000. Developments in robotic cardiac surgery. Curr Opin Cardiol 15:378-87.nKappert U, Cichon R, Schneider J, Schramm I, Schueler S. 2000. Closed chest bilateral mammary artery grafting in double-vessel coronary artery disease. Ann Thorac Surg 70:1699-701.nKappert U, Schneider J, Cichon R, et al. 2000. Wrist-enhanced instrumentation: moving toward totally endoscopic coronary artery bypass grafting. Ann Thorac Surg 70:1105-8.nKlima U, Falk V, Maringka M, et al. Magnetic vascular coupling for distal anastomosis in coronary artery bypass grafting: a multicenter trial. J Thorac Cardiovasc Surg. In press.nMohr FW, Falk V, Diegeler A, et al. 2001. Computer-enhanced "robotic" cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg 121:842-53.nNiinami H, Takeuchi Y, Ichikawa S, et al. 2001. Coronary artery bypass-grafting using interrupted anastomosis with the U-clip [in Japanese]. Kyobu Geka 54:1003-6.n
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