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Wiedemann D, Schachner T, Bonaros N, Lehr EJ, Wehman B, Hong P, Gibber M, Lee J, Bonatti J. Robotic Totally Endoscopic Coronary Artery Bypass Grafting in Men and Women: Are There Sex Differences in Outcome? Ann Thorac Surg 2013; 96:1643-7. [DOI: 10.1016/j.athoracsur.2013.05.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
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Deshpande SP, Fitzpatrick M, Grigore AM. Pro: Robotic surgery is the preferred technique for coronary artery bypass graft (CABG) surgery. J Cardiothorac Vasc Anesth 2013; 27:802-5. [PMID: 23849526 DOI: 10.1053/j.jvca.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Seema P Deshpande
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Seco M, Edelman JJB, Yan TD, Wilson MK, Bannon PG, Vallely MP. Systematic review of robotic-assisted, totally endoscopic coronary artery bypass grafting. Ann Cardiothorac Surg 2013; 2:408-18. [PMID: 23977616 DOI: 10.3978/j.issn.2225-319x.2013.07.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/25/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Advancements in surgical robotic technology over the last two decades have enabled coronary artery bypass grafting to be performed totally endoscopically, and have the potential to significantly change clinical practice in the future. METHODS A systematic review of studies reporting clinical outcomes of total endoscopic coronary artery bypass grafting (TECABG) was performed. RESULTS 14 appraised studies included 880 beating heart TECABGs, 360 arrested heart TECABGs, 633 one-vessel operations and 357 two-vessel operations. Patients were generally low-risk. There was a significant learning curve. The weighted means for short-term beating heart and arrested heart TECABG results respectively were: intraoperative exclusion rate of 5.7% and 1.9%, intraoperative conversion rate of 5.6% and 15.0%, all-cause mortality of 1.2% and 0.4%, stroke of 0.7% and 0.8%, myocardial infarction of 0.8% and 1.8%, new onset atrial fibrillation of 10.7% and 5.1% and post-operative reintervention rate of 2.6% and 2.3%. The overall rate of short term postoperative graft patency for beating heart and arrested heart TECABG was 98.3% and 96.4% respectively. CONCLUSIONS Appropriate patient selection was important in minimizing the risk of intraoperative and postoperative complications. Short-term outcomes of both beating and arrested heart TECABG were acceptable, but results so far have been heterogeneous. There were fewer studies reporting intermediate to long-term outcomes, but results were encouraging, and further investigation and development of the procedure is warranted.
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; ; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
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Deshpande SP, Lehr E, Odonkor P, Bonatti JO, Kalangie M, Zimrin DA, Grigore AM. Anesthetic Management of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Surgery (TECAB). J Cardiothorac Vasc Anesth 2013; 27:586-99. [DOI: 10.1053/j.jvca.2013.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 11/11/2022]
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Hybrid coronary revascularization as a safe, feasible, and viable alternative to conventional coronary artery bypass grafting: what is the current evidence? Minim Invasive Surg 2013; 2013:142616. [PMID: 23691303 PMCID: PMC3649801 DOI: 10.1155/2013/142616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/13/2013] [Indexed: 11/30/2022] Open
Abstract
The “hybrid” approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior
descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is
performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium
against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between
93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter
hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC)
transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients
treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated
patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of
multivessel coronary artery disease in a selected patient population.
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Kim JE, Jung SH, Kim GS, Kim JB, Choo SJ, Chung CH, Lee JW. Surgical Outcomes of Congenital Atrial Septal Defect Using da VinciTM Surgical Robot System. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:93-7. [PMID: 23614093 PMCID: PMC3631797 DOI: 10.5090/kjtcs.2013.46.2.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive cardiac surgery has emerged as an alternative to conventional open surgery. This report reviews our experience with atrial septal defect using the da VinciTM surgical robot system. MATERIALS AND METHODS This retrospective study included 50 consecutive patients who underwent atrial septal defect repair using the da VinciTM surgical robot system between October 2007 and May 2011. Among these, 13 patients (26%) were approached through a totally endoscopic approach and the others by mini-thoracotomy. Nineteen patients had concomitant procedures including tricuspid annuloplasty (n=10), mitral valvuloplasty (n=9), and maze procedure (n=4). The mean follow-up duration was 16.9±10.4 months. RESULTS No remnant interatrial shunt was detected by intraoperative or postoperative echocardiography. The atrial septal defects were mainly repaired by Gore-Tex patch closure (80%). There was no operative mortality or serious surgical complications. The aortic cross clamping time and cardiopulmonary bypass time were 74.1±32.2 and 157.6±49.7 minutes, respectively. The postoperative hospital stay was 5.5±3.3 days. CONCLUSION The atrial septal defect repair with concomitant procedures like mitral valve repair or tricuspid valve repair using the da VinciTM system is a feasible method. In addition, in selected patients, complete port access can be helpful for better cosmetic results and less musculoskeletal injury.
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Affiliation(s)
- Ji Eon Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 7:3-8. [PMID: 22576029 DOI: 10.1097/imi.0b013e3182552ea8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Closed-chest totally endoscopic coronary artery bypass grafting (TECAB) is feasible using robotic technology. During the early phases, TECAB was restricted to single bypass grafts to the left anterior descending artery system. Because most patients referred for coronary artery bypass surgery have multivessel disease, development of endoscopic multiple bypass grafting is mandatory. Experimental work on multivessel TECAB was carried out in the early 2000s, and first clinical cases were already performed. With further technological development of operating robots, double, triple, and quadruple TECAB has become feasible both on the arrested heart and on the beating heart. To date, 161 cases of multivessel TECAB using the da Vinci telemanipulation systems are published in the literature. The main advances enabling multivessel TECAB were the availability of a robotic endostabilizer for beating heart procedures and increased surgeon skills using remote access heart-lung machine perfusion and endo-cardioplegia. Both internal mammary arteries can be harvested and both radial artery and vein graft can be used in multivessel TECAB. Y-grafting and sequential grafting are feasible. Multivessel endoscopic surgical revascularization can be combined with percutaneous coronary interventions in advanced hybrid coronary revascularization. Time requirements for multivessel TECAB are significant, and conversion rates to larger thoracic incisions are higher than those observed for single-vessel TECAB. Clinical short- and long-term outcomes, however, seem to meet the standards of open coronary bypass surgery through sternotomy. The main advantages of multivessel TECAB are a completely preserved sternum, use of double internal mammary artery even in risk groups, and a remarkably short recovery time.
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Robotic total endoscopic double-vessel coronary artery bypass grafting--state of procedure development. J Thorac Cardiovasc Surg 2013; 144:1061-6. [PMID: 23079007 DOI: 10.1016/j.jtcvs.2012.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/28/2012] [Accepted: 08/03/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Robotic total endoscopic coronary artery bypass grafting (TECAB) has been under development for 10 years. With increasing experience and technological improvement, double-vessel TECAB has become feasible. The aim of the present study was to compare the current outcomes of single- and double-vessel TECAB. METHODS Between 2001 and 2011, 484 patients underwent TECAB by 4 surgeons at 2 institutions. The median patient age was 60 years (range, 31-90), and the median European System for Cardiac Operative Risk Evaluation was 2 (range, 0-13). Single-vessel (n = 334) and double-vessel (n = 150) procedures were performed using the da Vinci, da Vinci S, and da Vinci Si robotic systems. RESULTS Compared with the single-vessel procedure, double-vessel TECAB required a longer operative time (median, 375 minutes; range, 168-795; vs median, 240; range, 112-605; P < .001) and had an increased conversion rate to a larger thoracic incision (31/150 [20.7%] vs 31/334 [9.3%]; P < .001). The median ventilation time was 10 hours (range, 0-288) for double-vessel versus 8 hours (range, 0-278) for single-vessel procedures (P = .006). The hospital stay was comparable, with 6 days (range, 2-27) for double-vessel TECAB and 6 days (range, 2-33) for single-vessel TECAB (P = .794). Perioperative mortality was 0.3% (1/334) with single-vessel TECAB and 2.0% (3/150) with double-vessel TECAB (P = .090). Freedom from major adverse cardiac and cerebral events at 5 years was similar after double- and single-vessel TECAB (73.5% vs 83.1%, P = .150). The 5-year survival was 95.8% and 93.9% (P = .708). CONCLUSIONS Double-vessel TECAB appears feasible and reproducible. The operative times were longer and the conversion rates to a larger thoracic incision were greater than with single-vessel TECAB. Also, the postoperative ventilation time was longer. Other perioperative morbidity and mortality and the recovery time and long-term clinical outcomes, however, were comparable.
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Bonaros N, Schachner T, Lehr E, Kofler M, Wiedemann D, Hong P, Wehman B, Zimrin D, Vesely MK, Friedrich G, Bonatti J. Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg 2013; 95:803-12. [PMID: 23312792 DOI: 10.1016/j.athoracsur.2012.09.071] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 08/13/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Robotic technology has enabled totally endoscopic coronary artery bypass (TECAB) grafting. Little information is available on factors associated with successful and safe performance of TECAB. We report a 10-year multicenter experience with 500 cases, elucidating on predictors of success and safety in TECAB procedures. METHODS Between 2001 and 2011, 500 patients (364 [73%] men; 136 [27%] women; median age [minimum-maximum] 60 years [31-90 years], median EuroSCORE 2 [0-13]), underwent TECAB. Single, double, triple, and quadruple TECAB was performed in 334, 150, 15, and 1 patient, respectively. Univariate analysis and binary regression models were used to identify predictors of success and safety. Success was defined as freedom from any adverse event and conversion procedure, safety was defined as freedom from major adverse cardiac and cerebral events, major vascular injury, and long-term ventilation. RESULTS Success and safety rates were 80% (400 cases) and 95% (474 cases), respectively. Intraoperative conversions to larger thoracic incisions were required in 49 (10%) patients. The median operative time was 305 minutes (112-1,050 minutes), and the mean lengths of stay in the intensive unit (ICU) and in hospital were 23 hours (11-1,048 hours) and 6 days (2-4 days), respectively. Independent predictors of success were single-vessel TECAB (p = 0.004), arrested-heart (AH)-TECAB (p = 0.027), non-learning curve case (p = 0.049), and transthoracic assistance (p = 0.035). The only independent predictor of safety was EuroSCORE (p = 0.002). CONCLUSIONS Single-vessel and multivessel TECAB procedures can be safely performed with good reproducible results. Predictors of success include procedure simplicity and non-learning curve cases, whereas predictors of safety are mainly associated with patient selection.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, University of Maryland, Baltimore, Maryland; Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Hybrid Coronary Revascularization Using Robotic Totally Endoscopic Surgery: Perioperative Outcomes and 5-Year Results. Ann Thorac Surg 2012; 94:1920-6; discussion 1926. [DOI: 10.1016/j.athoracsur.2012.05.041] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/08/2012] [Accepted: 05/11/2012] [Indexed: 01/09/2023]
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Lee JD, Vesely MR, Zimrin D, Bonatti J. Advanced hybrid coronary revascularization with robotic totally endoscopic triple bypass surgery and left main percutaneous intervention. J Thorac Cardiovasc Surg 2012; 144:986-7. [PMID: 22713300 DOI: 10.1016/j.jtcvs.2012.05.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/04/2012] [Accepted: 05/17/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey D Lee
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
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Wiedemann D, Bonaros N, Schachner T, Weidinger F, Lehr EJ, Vesely M, Bonatti J. Surgical problems and complex procedures: Issues for operative time in robotic totally endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143:639-647.e2. [DOI: 10.1016/j.jtcvs.2011.04.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/05/2011] [Accepted: 04/26/2011] [Indexed: 11/26/2022]
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Athanasiou T, Ashrafian H, Rowland SP, Casula R. Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption. Future Cardiol 2012; 7:511-22. [PMID: 21797747 DOI: 10.2217/fca.11.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robotic cardiac surgery utilizes the most advanced surgical technology to offer patients a minimally invasive alternative to open surgery in the treatment of a broad range of cardiac pathologies. Although robotics may offer substantial benefits to physicians, patients and healthcare institutions, there are important barriers to its adoption that includes inadequate funding, competition from alternate therapies and challenges in training. There is a growing body of evidence to demonstrate the efficacy of robotic cardiac surgery. Technological innovations are improving patient safety and expanding the indications for robotic cardiac surgery beyond the treatment of mitral valve and coronary artery disease. Robotic cardiac surgery is rapidly becoming a feasible, safe and effective option for the definitive treatment of cardiac disease in the context of 21st century challenges to healthcare provision such as diabetes, obesity and an aging population.
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Affiliation(s)
- Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College London, London W2 1NY, UK.
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Bonatti J, Lee JD, Bonaros N, Schachner T, Lehr EJ. Robotic Totally Endoscopic Multivessel Coronary Artery Bypass Grafting Procedure Development, Challenges, Results. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Johannes Bonatti
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Jeffrey D. Lee
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Nikolaos Bonaros
- †University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Schachner
- †University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Eric J. Lehr
- ‡Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA USA
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Bonaros N, Schachner T, Wiedemann D, Bonatti J. Invited commentary. Ann Thorac Surg 2011; 92:2234. [PMID: 22115232 DOI: 10.1016/j.athoracsur.2011.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/19/2011] [Accepted: 08/24/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Nikolaos Bonaros
- Innsbruck Medical University, Cardiac Surgery, Anichstrasse 35, 6020 Innsbruck, Austria.
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66
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Balkhy HH, Wann LS, Krienbring D, Arnsdorf SE. Integrating coronary anastomotic connectors and robotics toward a totally endoscopic beating heart approach: review of 120 cases. Ann Thorac Surg 2011; 92:821-7. [PMID: 21871264 DOI: 10.1016/j.athoracsur.2011.04.103] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/20/2011] [Accepted: 04/26/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Endoscopic coronary bypass has been a difficult procedure to perform. The recent introduction of the Intuitive EndoWrist stabilizer (Intuitive Surgical, Sunnyvale, CA) has facilitated this procedure robotically on the beating heart. The addition of anastomotic connectors allows a significant improvement in the execution of this technically demanding procedure. We report on our first 120 cases of totally endoscopic, beating heart connector coronary artery bypass grafting integrating these technologies. METHODS From January 2008 to April 2010, 120 patients (age range 43 to 86 years, 72% male) underwent either single or multivessel all arterial, totally endoscopic coronary artery bypass grafting using the da Vinci robot with the aid of the Flex A distal anastomotic device (Cardica, Redwood City, CA). Patients with multivessel disease involving branches of the right coronary and circumflex arteries underwent hybrid revascularization with stents. Early and midterm clinical outcomes were evaluated for all patients. Eighty-five internal mammary artery grafts in 68 patients were evaluated at a mean of 4 months using multidetector computed tomography and formal angiography (in 18 hybrid patients). RESULTS Mean hospital stay was 3.3±2.4 days. There was 1 postoperative death (the same patient had a stroke secondary to carotid disease), and 1 postoperative myocardial infarction. Two patients were converted to minithoracotomy and 1 patient was converted to sternotomy. One patient required cardiopulmonary bypass support through the femoral cannulation during the procedure. Mean intraoperative transit time flow in all the internal mammary artery grafts was 76 cc/minute±43, and pulsatility index of 1.5±0.5. Of the 85 grafts evaluated angiographically, 80 were patent at a mean of 4 months (94.1%). CONCLUSIONS Totally endoscopic beating heart connector coronary bypass using the da Vinci robot with the Flex A anastomotic device is a safe and reproducible procedure. A significant learning curve is involved and experience with anastomotic devices in the open setting is necessary. Long-term follow-up of graft patency and patient outcomes is warranted.
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Affiliation(s)
- Husam H Balkhy
- Center for Robotic and Minimally Invasive Cardiac Surgery, The Wisconsin Heart Hospital, Milwaukee, Wisconsin, USA.
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69
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Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, Kim CG, Choi IJ, Lee JS, Kook MC, Rhee JY, Park SR, Kim YW. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol 2011; 38:57-63. [PMID: 21945625 DOI: 10.1016/j.ejso.2011.09.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/14/2011] [Accepted: 09/05/2011] [Indexed: 12/14/2022] Open
Abstract
AIMS The authors aimed to compare the surgical performance and the short-term clinical outcomes of robotic assisted laparoscopic distal gastrectomy (RADG) with laparoscopy-assisted distal gastrectomy (LADG) in distal gastric cancer patients. METHOD From April 2009 to August 2010, 62 patients underwent LADG and 30 patients underwent RADG for preoperative stage I distal gastric cancer by one surgeon at the National Cancer Center, Korea. Surgical performance was measured using lymph node (LN) dissection time and number of retrieved LNs, which were viewed as surrogates of technical ease and oncologic quality. RESULTS In clinicopathologic characteristics, mean age, depth of invasion and stage were significantly different between the LADG and RADG group. Mean dissection time at each LN station was greater in the RADG group, but no significant intergroup difference was found for numbers of retrieved LNs. Furthermore, proximal resection margins were smaller, and hospital costs were higher in the RADG group. In terms of the RADG learning curve, mean LN dissection time was smaller in the late RADG group (n = 15) than in the early RADG group (n = 15) for 4sb/4d, 5, 7-12a stations, but numbers of retrieved LNs per station were similar. CONCLUSION With the exception of operating time and cost, the numbers of retrieved LNs and the short-term clinical outcomes of RADG were found to be comparable to those of LADG, despite the surgeon's familiarity with LADG and lack of RADG experience. Further studies are needed to evaluate objectively ergonomic comfort and to quantify the patient benefits conferred by robotic surgery.
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Affiliation(s)
- B W Eom
- Gastric Cancer Branch, National Cancer Center, 111 Jeongbalsanro, Ilsandong-Gu, Goyang-Si, Gyeonggi-Do 410-769, South Korea
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Bonatti J, Schachner T, Bonaros N, Lehr EJ, Zimrin D, Griffith B. Robotically assisted totally endoscopic coronary bypass surgery. Circulation 2011; 124:236-44. [PMID: 21747068 DOI: 10.1161/circulationaha.110.985267] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Johannes Bonatti
- Department of Surgery, Division of Cardiac Surgery, University of Maryland at Baltimore, 22 S Greene St, N4W94, Baltimore, MD 21201, USA.
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Schachner T, Bonaros N, Wiedemann D, Lehr EJ, Weidinger F, Friedrich G, Zimrin D, Bonatti J. Robotically assisted minimal invasive and endoscopic coronary bypass surgery. Eur Surg 2011. [DOI: 10.1007/s10353-011-0026-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schachner T, Bonaros N, Wiedemann D, Lehr EJ, Weidinger F, Feuchtner G, Zimrin D, Bonatti J. Predictors, causes, and consequences of conversions in robotically enhanced totally endoscopic coronary artery bypass graft surgery. Ann Thorac Surg 2011; 91:647-53. [PMID: 21352972 DOI: 10.1016/j.athoracsur.2010.10.072] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/24/2010] [Accepted: 10/26/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Totally endoscopic coronary artery bypass graft surgery (TECAB), using the da Vinci telemanipulator, has become a reproducible operation at dedicated centers. As in every endoscopic operation, conversion is an important and probably inevitable issue. METHODS We performed robotic TECAB in 326 patients (age, 60 years; range, 31 to 90 years); 242 were single-vessel and 84 were multivessel TECAB. RESULTS Forty-six of 326 patients (14%) were converted to a larger incision (minithoracotomy, n = 5; sternotomy, n = 41). Left internal mammary artery injury (n = 7), epicardial injury (n = 4), balloon endoocclusion problems (n = 7), and anastomotic problems (n = 18) were common reasons for conversions. Conversion rate was significantly less for single-vessel versus multivessel TECABs (10% versus 25%; p = 0.001). Non-learning-curve case (7% versus 21%; p < 0.001) and transthoracic assistance (11% versus 22%; p = 0.018) were associated with lower conversion rates. In multivariate analysis, learning-curve case was the only independent predictor of conversion (p = 0.005). Conversion translated into increased packed red blood cell transfusion in the operating room (3 versus 0 units; p < 0.001), longer ventilation time (14 versus 8 hours; p < 0.001), and intensive care unit stay (45 versus 20 hours; p = 0.001). Hospital mortality was 0.6% in this series, with 1 patient in the conversion group (2.2%) and 1 patient in the nonconverted group (0.4%; not significant). Five-year survival was 98% in nonconverted patients and 88% in converted patients (p = 0.018). There was no difference in freedom from angina or freedom from major adverse cardiac and cerebral events. CONCLUSIONS Conversion in TECAB is primarily learning curve-dependent and associated with increased morbidity, but does not significantly affect hospital mortality. Both nonconverted and converted patients show good long-term survival, which is comparable to patients undergoing open sternotomy coronary artery bypass grafting. Long-term freedom from angina or freedom from major adverse cardiac and cerebral events is not influenced by conversion.
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Affiliation(s)
- Thomas Schachner
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Bonaros N, Schachner T, Wiedemann D, Weidinger F, Lehr E, Zimrin D, Friedrich G, Bonatti J. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and techniques from a two-center experience. Eur J Cardiothorac Surg 2011; 40:783-7. [PMID: 21459599 DOI: 10.1016/j.ejcts.2011.01.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 11/18/2022] Open
Abstract
Hybrid coronary revascularization combining minimally invasive coronary surgery and percutaneous coronary intervention (PCI) allows sternal preserving treatment of multivessel coronary disease. The main principle of the technique includes placement of mammary artery graft to the left anterior descending coronary artery (LAD) and performance of PCI in non-LAD target vessels. This principle is based on increasing data showing equivalent results of PCI with coronary revascularization using saphenous vein grafts in selected patients. Providing that perioperative and long-term results are as good as the results of conventional surgical revascularization, this option seems to be quite appealing for patients and referring cardiologists. This concept has been designed to allow rapid rehabilitation and minimize periprocedural pain under concomitant preservation of the patient's body integrity. Robotically assisted endoscopic approaches for hybrid coronary revascularization set the pace for a closed-chest treatment of multivessel coronary disease. The time point of PCI, the use of different anticoagulation protocols as well as the stent selection are some of the variables, which affect outcome. We additionally report on the midterm results of 130 after-closed-chest hybrid-coronary procedures in two institutions. Hybrid procedures using robotic technology and PCI allow closed chest treatment of multivessel coronary artery disease. Single- and double-bypass grafts are feasible and simultaneous interventions can be performed. The overall safety of the procedure seems to be adequate and perioperative clinical results are satisfactory. Intermediate term survival and freedom from angina are excellent.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Bibliography. Current world literature. Thoracic anesthesia. Curr Opin Anaesthesiol 2011; 24:111-3. [PMID: 21321525 DOI: 10.1097/aco.0b013e3283433a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zimrin D, Bonatti J, Vesely MR, Lehr EJ. Hybrid Coronary Revascularization: An Overview of Options for Anticoagulation and Platelet Inhibition. Heart Surg Forum 2010; 13:E405-8. [DOI: 10.1532/hsf98.20101157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khoshbin E, Martin S, Foale R, Darzi A, Casula R. Robotically assisted atraumatic coronary artery bypass: a feasible option for off-pump coronary surgery. J Robot Surg 2010; 4:117-22. [PMID: 27628777 DOI: 10.1007/s11701-010-0197-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 05/24/2010] [Indexed: 11/25/2022]
Abstract
This retrospective study of the largest single center experience (100 patients) with off-pump robotically assisted coronary procedures in the United Kingdom (April 2002-June 2008) aimed to rationalize patient selection, describe the technique, and determine the learning curve, technical feasibility and operative outcome of robotically assisted Atraumatic Coronary Artery Bypass (ACAB). Selected patients underwent either a robotic Totally Endoscopic Coronary Artery Bypass (12) or robotically assisted ACAB (88) using a standard Da Vinci robot with three arms. A fifth of all cases had percutaneous interventions as part of a hybrid strategy. The majority of patients were overweight men. After one hundred robotic coronary procedures, this operation is now performed as part of a routine theatre list. The mean operative and total procedure times for robotically assisted atraumatic procedures were 157 and 238 min, respectively. These measurements were significantly less in the atraumatic than the totally endoscopic group with a 34.3 and 20.6% reduction, respectively (P < 0.001; equal variance not assumed). The procedural learning curve was short and independent from internal thoracic artery harvesting. We have proven conclusively that robotically assisted ACAB is feasible, more so than the totally endoscopic procedure in this particular setting. Even in the absence of an ideal stabilizer device, this procedure causes minimal disruption to the daily operating room schedule. We have also proven that body mass index is a weak predictor of the ease of robotic internal thoracic artery harvesting and should not affect patient selection.
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Affiliation(s)
- Espeed Khoshbin
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Shirley Martin
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Rodney Foale
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Ara Darzi
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Desai PH, Tran R, Steinwagner T, Poston RS. Challenges of telerobotics in coronary bypass surgery. Expert Rev Med Devices 2010; 7:165-8. [PMID: 20214421 DOI: 10.1586/erd.09.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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