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J Thorac Cardiovasc Surg 2002;123:1125-1131
© 2002 The American Association for Thoracic Surgery
Evolving Technology (ET) |
From the Department of Thoracic and Cardiovascular Surgerya and the Department of Anesthesiology, Intensive Care and Pain Therapy,b Johann Wolfgang Goethe University, Frankfurt, Germany.
Received for publication March 27, 2001. Revisions requested May 17, 2001; revisions received Oct 9, 2001. Accepted for publication Oct 24, 2001. Address for reprints: Selami Dogan, MD, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany (E-mail: S.Dogan{at}em.uni-frankfurt.de).
Background: Robotically enhanced telemanipulation is a new powerful tool for minimally invasive procedures that allows totally endoscopic cardiac surgery. Between June 1999 and February 2001, 45 robotically enhanced totally endoscopic coronary artery bypass grafting procedures on the arrested heart were performed at our institution with the use of the da Vinci telemanipulation system (Intuitive Surgical, Inc, Mountain View, Calif).
Methods: In 37 patients a single-vessel totally endoscopic coronary bypass operation was performed. Eight patients had different types of multivessel revascularization with both internal thoracic arteries. The initial conversion rate was 22% and dropped to 5% in the last 20 patients. Two patients required reexploration via median sternotomy. The first 22 patients had excellent graft patency on discharge. The procedural time for single-vessel totally endoscopic bypass was 4.2 ± 0.4 hours, bypass time was 136 ± 11 minutes, and aortic crossclamp time amounted to 61 ± 5 minutes.
Conclusion: The present data show the feasibility of closed chest single- and double-vessel revascularization, with good clinical results. However, procedural time is prolonged and the complex endoscopic and endoaortic occlusion techniques, as well as the extensive anesthesiologic monitoring, are demanding. The need for conversion to an open procedure diminished after a relatively short learning curve. All postulated benefits of totally endoscopic surgery other than excellent cosmesis must be evaluated in larger cohorts.
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