A Porcine Beating Heart Model for Robotic Coronary Artery Surgery

Authors

  • Harry W. Donias
  • Ted Schwartz
  • Daniel G. Tang
  • Abe DeAnda
  • Harold A. Tabaie
  • Douglas W. Boyd
  • Hratch L. Karamanoukian

DOI:

https://doi.org/10.1532/hsf.944

Abstract

Background: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis.

Methods: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test.

Results: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P < .0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P = .0049). Conclusions: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

References

Damiano RJ, Ehrman WJ, Ducko CT, et al. 2000. Initial United States clinical trial of robotically assisted endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg 119:77-82.nDonias HW, Karamanoukian RL, Glick PL, Bergsland J, Karamanoukian HL. 2002. Survey of resident training in robotic surgery. Am Surg 68:177-81.nKaramanoukian HL, Panos AL, Bergsland J, Salerno TA. 2000. Perspectives of a cardiac surgery resident in training on off-pump coronary bypass operations. Ann Thorac Surg 69:42-5.nMack MJ. 2001. Minimally invasive and robotic surgery. JAMA 285:568-72.nRicci M, Karamanoukian HL, D'Ancona G, et al. 2000. Survey of resident training in beating heart operations. Ann Thorac Surg 70:479-82.nStanbridge RDL, O'Regan D, Cherian A, Ramanan R. 1999. Use of a beating heart model for training surgeons in beating heart surgery. Heart Surg Forum 2:300-4.nStephenson ER Jr, Ducko CT, Sankholkar S, Hoenicke EM, Prophet GA, Damiano RJ. 1999. Computer-assisted endoscopic coronary artery bypass anastomoses: a chronic animal study. Ann Thorac Surg 68:838-43.nStephenson ER Jr, Sankholkar S, Ducko CT, Damiano RJ. 1998. Robotically assisted microsurgery for endoscopic coronary artery bypass grafting. Ann Thorac Surg 66:1064-7.nTabaie HA, Reinbolt JA, Graper WP, Kelly TF, Connor MA. 1999. Endoscopic coronary artery bypass graft (ECABG) procedure with robotic assistance. Heart Surg Forum 2:310-7.n

Published

2005-02-07

How to Cite

Donias, H. W., Schwartz, T., Tang, D. G., DeAnda, A., Tabaie, H. A., Boyd, D. W., & Karamanoukian, H. L. (2005). A Porcine Beating Heart Model for Robotic Coronary Artery Surgery. The Heart Surgery Forum, 6(4), 249-253. https://doi.org/10.1532/hsf.944

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