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Watanabe T, Kitahara H, Nisivaco S, Coleman C, Patel B, Balkhy HH. Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass: Impact of Chest Wall Dimensions in Single and Multivessel Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:290-297. [PMID: 38835206 DOI: 10.1177/15569845241252170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE There can be anatomical constraints on patient selection for minimally invasive surgery. For example, robot-assisted coronary artery bypass was reported to be more challenging when patients had a cardiothoracic ratio >50% and a sternum-vertebra anteroposterior and transverse diameter ratio <0.45. We sought to examine the impact of chest wall anatomic parameters on surgical outcomes in our totally endoscopic coronary artery bypass (TECAB) procedures. METHODS We retrospectively reviewed patients who underwent robotic TECAB, all of whom had a preoperative chest radiograph at our institution from July 2017 to October 2021. The cohort was divided into 2 groups, which were patients undergoing single-vessel grafting using the left internal thoracic artery (ITA; group 1) and patients undergoing multivessel grafting with bilateral ITA grafts (group 2). We measured several anatomical parameters from the preoperative chest radiograph. RESULTS A total of 352 patients undergoing TECAB were retrospectively analyzed. After exclusions, 193 were included in this study. In group 1 (n = 91), no parameters correlated with operative time. In group 2 (n = 102), a significant negative correlation was observed between operative time and the sternum-vertebrae anteroposterior diameter (rs = -0.228, P = 0.022) and lung anteroposterior diameter (rs = -0.246, P = 0.013). To confirm these results in group 2, a propensity-matched analysis was performed and showed a statistically significant difference in surgical time based on chest anteroposterior diameters. CONCLUSIONS In single-vessel robotic TECAB, chest wall anatomic dimensions measured on chest radiograph did not affect operative time. In multivessel cases with bilateral ITA grafts, larger anteroposterior diameter correlated with shorter operative times.
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Affiliation(s)
- Tatsuya Watanabe
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Hiroto Kitahara
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Sarah Nisivaco
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Charocka Coleman
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Brooke Patel
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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Miller CL, Kocher M, Koweek LH, Zwischenberger BA. Use of computed tomography (CT) for preoperative planning in patients undergoing coronary artery bypass grafting (CABG). J Card Surg 2022; 37:4150-4157. [PMID: 36183391 DOI: 10.1111/jocs.17000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/06/2023]
Abstract
Surgical planning for coronary artery bypass grafting (CABG) can be enhanced with the use of computed tomographic (CT) imaging to better understand the surgical field for optimal conduct of the case as well as risk assessment for outcomes. CABG via primary sternotomy, redo sternotomy, and minimally-invasive thoracotomy each pose unique surgical considerations and risks that can be better characterized with a preoperative CT scan. CT and CT angiographic (CTA) techniques with or without intravenous (IV) contrast can provide a noninvasive assessment of the vascular and bony structures and direct surgical planning techniques. Herein we discuss the role of CT/CTA imaging of the chest in preoperative planning of different strategies of CABG.
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Affiliation(s)
- Cynthia L Miller
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Madison Kocher
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lynne H Koweek
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brittany A Zwischenberger
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Bonatti J, Wallner S, Winkler B, Grabenwöger M. Robotic totally endoscopic coronary artery bypass grafting: current status and future prospects. Expert Rev Med Devices 2020; 17:33-40. [PMID: 31829047 DOI: 10.1080/17434440.2020.1704252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Totally endoscopic coronary artery bypass grafting (TECAB) can only be performed in a reproducible manner using robotic technology. This operation has been developed for more than 20 years seeing three generations of surgical robots. TECAB can be carried out beating heart but also on the arrested heart. Single and multiple grafts can be placed and TECAB can be combined with percutaneous coronary intervention in hybrid procedures.Areas covered: This review outlines indications for the procedure, the surgical technique, and the postoperative care. Intra- and postoperative results as available in the literature are reported. Further areas focus on technological development, training methods, learning curves as well as on cost. Finally, we give an outlook on the potential future of this operation.Expert opinion: Robotic TECAB represents a complex, sophisticated but safe, and over-the-years grown procedure. Even though results seem to be in line with conventional coronary surgery worldwide adoption still has been slow probably due to procedure times, costs and learning curves. Main advantages of TECAB are minimized surgical trauma and subsequent reduction of postoperative healing time. With the current introduction of new robotic devices, a new era of procedure development is on its way.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardio-Vascular Surgery, Vienna North Hospital and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardio-Vascular Surgery, Vienna North Hospital and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardio-Vascular Surgery, Vienna North Hospital and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardio-Vascular Surgery, Vienna North Hospital and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
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Morbid Obesity Does not Increase Morbidity or Mortality in Robotic Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:434-439. [PMID: 29232296 DOI: 10.1097/imi.0000000000000435] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Morbid obesity (body mass index ≥ 35 kg/m) usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. METHODS We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. RESULTS A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years). The robotic procedures were the following: totally endoscopic beating heart coronary artery bypass (n = 263), mitral valve surgery (n = 138), arrhythmia surgery (n = 33), adult congenital surgery (n = 16), pericardiectomy (n = 11), and others (n = 25). The cohorts were divided into the following: normal weight (body mass index < 25, n = 123), overweight (body mass index = 25 to < 30, n = 182), obesity (body mass index = 30 to < 35, n = 105), and morbid obesity (body mass index ≥ 35, n = 76). Morbidly obese patients had a higher rate of hypertension, dyslipidemia, and diabetes mellitus compared with normal or overweight patients. There were no significant differences in morbidity, mean length of intensive care unit stay (2.10 ± 4.27 days), and hospital stay (4.48 ± 5.61 days) among the groups. In-hospital mortality was 1.4% (7/486) with nonsignificant difference. CONCLUSIONS Outcomes of robotic heart surgery in morbidly obese patients in our center were acceptable. Over a broad range of cardiac surgical procedures, morbid obesity was not associated with increased morbidity or mortality when these procedures were performed using a robotic approach. These findings can be beneficial in managing this challenging group of patients.
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Le HND, Nguyen H, Wang Z, Opfermann J, Leonard S, Krieger A, Kang JU. Demonstration of a laparoscopic structured-illumination three-dimensional imaging system for guiding reconstructive bowel anastomosis. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 29797865 PMCID: PMC5964336 DOI: 10.1117/1.jbo.23.5.056009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/30/2018] [Indexed: 05/11/2023]
Abstract
This paper reports the development and system analysis of a laparoscopic system based on structured illumination technique capable of three-dimensional (3-D) reconstruction of porcine intestine during surgical anastomosis (connection of tubular structures). A calibration target is used to validate the system performance and results show a depth of field of 20 mm with an accuracy of 0.008 mm and precision of 0.25 mm. The imaging system is used to reconstruct a quantitative 3-D depth measurement of ex vivo porcine bowel tissues to mimic an end-to-end bowel anastomosis scenario. We demonstrate that the system can detect a suture in the tissue and map homogeneous surfaces of the intestine with different tissue pigments, affirming the feasibility for depth quantization for guiding and assisting medical diagnostic decisions in anastomosis surgery.
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Affiliation(s)
- Hanh N. D. Le
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Hieu Nguyen
- Catholic University of America, Department of Mechanical Engineering, Washington, DC, United States
| | - Zhaoyang Wang
- Catholic University of America, Department of Mechanical Engineering, Washington, DC, United States
| | - Justin Opfermann
- Children’s National Health System, Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, United States
| | - Simon Leonard
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Axel Krieger
- University of Maryland, Department of Mechanical Engineering, College Park, Maryland, United States
| | - Jin U. Kang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
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Kitahara H, Patel B, McCrorey M, Nisivaco S, Balkhy HH. Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroto Kitahara
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Brooke Patel
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Mackenzie McCrorey
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Sarah Nisivaco
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Husam H. Balkhy
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL USA
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Medical robots in cardiac surgery - application and perspectives. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:79-83. [PMID: 28515758 PMCID: PMC5404137 DOI: 10.5114/kitp.2017.66939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than one hundred thousand minimally invasive robotic surgical procedures every year. A surgical robot can be used by surgical teams on a rotational basis. The market of surgical robots used for cardiovascular and lung surgery was worth 72.2 million dollars in 2014 and is anticipated to reach 2.2 billion dollars by 2021. The analysis shows that Poland should have more than 30 surgical robots. Moreover, Polish medical teams are ready for the introduction of several robots into the field of cardiac surgery. We hope that this market will accommodate the Polish Robin Heart robots as well.
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Eligibility for Minimally Invasive Coronary Artery Bypass: Examination of Epicardial Adipose Tissue Using Computed Tomography. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:121-126. [PMID: 28338554 DOI: 10.1097/imi.0000000000000356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A variable that necessitates conversion to a conventional full-sternotomy coronary artery bypass procedure from a robotic-assisted endoscopic single-vessel small thoracotomy is the inability to visualize the left anterior descending coronary artery within the surrounding epicardial adipose tissue using the endoscopic camera. The purpose of this study was to determine whether anatomical properties of the epicardial adipose tissue examined using preoperative computed tomography (CT) images are able to predict and thus reduce the need for intraoperative conversion based on effective preoperative exclusion criteria. METHODS Retrospective analysis of patient preoperative CT angiography scans from both converted (n = 17) and successful robotic-assisted (n = 17) procedures was performed. Where possible, measurements of epicardial adipose tissue were acquired from axial slices, at the most accessible segment of the left anterior descending coronary artery. RESULTS Results indicate that patients who successfully underwent the endoscopic single-vessel small thoracotomy procedure (mean ± SD depth, 4.9 ± 1.9 mm) had significantly less epicardial adipose tissue (38%, P = 0.002) overlying the vessel toward the lateral chest wall than those who were converted to the full-sternotomy approach intraoperatively (mean ± SD depth, 7.9 ± 3.2 mm). Using this as a retrospective exclusion criterion reduces the conversion rate for this group by 47%, while maintaining a high specificity (94%). No significant differences exist between the two groups with respect to the remaining epicardial adipose tissue measurements or body mass index. CONCLUSIONS The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes.
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Dillon KEM, Johnson M, Chan IL, Kiaii B. Eligibility for Minimally Invasive Coronary Artery Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kate E. M. Dillon
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ian L. Chan
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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