Robotic coronary artery bypass grafting (CABG)—the Leipzig experience

Robotics in Cardiac Surgery

Minimally invasive surgery has revolutionized the surgical field over the last two decades. Robotic assisted surgery is the latest iteration towards less invasive techniques. Cardiac surgeons have slowly adapted minimally invasive and robotics techniques into their armamentarium. In particular, minimally invasive mitral valve surgery has evolved over the last decade and become the preferred method of mitral valve repair and replacement at certain specialized centres worldwide because of excellent results. We have developed a robotic mitral valve surgery program which utilizes the da Vinci® telemanipulation system allowing the surgeon to perform complex mitral valve repairs through 5mm port sites rather than a traditional median sternotomy. in this rapidly evolving field, we review the evolution and clinical results of robotically-assisted mitral valve surgery and take a look at the other cardiac surgical procedures for which da Vinci® is currently being used.

Outcomes in robotic cardiac surgery

The specialty of cardiac surgery has evolved substantially over the last 50 years, and surgical procedures that seemed impossible then are now commonly encountered in hospitals throughout the world. The latest development in this ever-evolving field is minimally invasive and robot-assisted procedures. In this article we will review the surgical outcomes reported for different series of procedures in cardiac surgery.

Image-guidance for surgical procedures

Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.

Towards robotic heart surgery: introduction of autonomous procedures into an experimental surgical telemanipulator system

The introduction of telemanipulator systems into cardiac surgery enabled the heart surgeon to perform minimally invasive procedures with high precision and stereoscopic view. For further improvement and especially for inclusion of autonomous action sequences, implementation of force-feedback is necessary. The aim of our study was to provide a robotic scenario giving the surgeon an impression very similar to open procedures (high immersion) and to enable autonomous surgical knot tying with delicate suture material. In this experimental set-up the feasibility of autonomous surgical knot tying is demonstrated for the first time using stereoscopic view and force feedback.

Comprehensive imaging of coronary artery disease: impact on contemporary treatment approaches

Coronary artery disease remains a major cause of mortality. Together with novel therapeutic and preventive approaches, important advances of coronary imaging are currently emerging. This article describes the status of modern coronary imaging and outlines expected future developments.

Robot-assisted pediatric surgery

Computer-enhanced robotic surgical systems have been increasingly used to facilitate complex minimal access surgical procedures. In adult patients, such systems have been used to perform a wide variety of operations including coronary artery bypass grafting, mitral valve repair, Roux-en-Y gastric bypass, colon resection, nephrectomy, and radical prostatectomy. In the field of pediatric surgery, the experience with robotic surgical systems has been more limited. However, with improvements in robotic technology, interest and experience with robotic pediatric surgery have grown rapidly. The purpose of this article is to review the current experimental and clinical literature regarding the use of robotic surgical systems in the pediatric patient population.

Surgical coronary revascularization remains relevant in the era of stents

PURPOSE OF REVIEW

The high prevalence of coronary artery disease (CAD) has inspired the development of technologies and techniques for coronary revascularization, including coronary artery bypass grafting (CABG) and catheter-based interventions (CBIs).

RECENT FINDINGS

Although CBIs allow the avoidance of general anesthesia, sternotomy, and cardiopulmonary bypass, CBIs-including those performed using drug-eluting stents-are associated with much higher rates of vascular reocclusion than is CABG. In addition, CBIs are not well suited to patients with diabetes or chronic total occlusion, both of which are extremely common in the CAD population. In contrast, CABG has proven effective for CAD patients with these conditions. The technology used in CABG continues to improve; ongoing innovations include off-pump coronary artery bypass; gene therapy to prevent restenosis; and endoscopic, video-assisted, and robot-assisted CABG using automated one-shot distal anastomotic devices.

SUMMARY

Although CBIs for CAD are now performed more often than surgical procedures, surgery remains an important treatment option.