title: Early experience with robotic technology for coronary artery surgery.
abstract: BACKGROUND
  To achieve an endoscopic coronary bypass anastomoses we performed a study with endoscopic robotic instrumentation and camera guidance using three-dimensional (3-D) visualization.
  
  
  METHODS
  The surgical robotic system ZEUS (Computer Motion Inc, Goleta, CA) consists of three interactive robotic arms and a control unit allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion Inc, Goleta, CA) positions the endoscope via voice control. The study had three phases. Phase I: In a phantom model, end-to-side anastomoses between vein grafts and the left anterior descending coronary artery (LAD) of 109 pig hearts were performed. Phase II: In 6 dogs (FBI, 20-25 kg) the left internal mammary artery (LIMA) was harvested endoscopically. During Port-Access (Heartport Inc, Redwood City, CA) cardiopulmonary bypass (CPB), LIMA and LAD were then anastomosed endoscopically with the help of telemetric ZEUS instruments (Computer Motion Inc). Phase III: A total of seven patients were operated on with help of the ZEUS system (Computer Motion Inc). After endoscopic LIMA harvesting and CPB using the Port-Access (Heartport Inc) system, the bypass graft (LIMA to LAD) was anastomosed endoscopically through three thoracic ports in 2 patients. Another 3 patients were operated on off-pump with regional stabilization and 2 patients with sternotomy and routine CPB.
  
  
  RESULTS
  The practice with the phantom model and the subsequent animal experiments allowed the surgeons to gain sufficient experience for the clinical setting. In the clinical cases, times for anastomoses ranged from 20 to 42 minutes. Median internal mammary artery flow rate was 74 mL per minute (range 36-110 mL per minute). One patient in the off-pump group was converted to CPB and routine anastomosis. All patients had an uneventful angiographic control and postoperative course.
  
  
  CONCLUSIONS
  Using telemetic technology, a completely endoscopic anastomosis of LIMA to LAD is possible on the arrested heart, as well as on the beating heart.
authors.affiliation: Department of Cardiac Surgery and Institute for Surgical Research, University Hospital Munich-Grosshadern, Munich, Germany. boehm@hch.med.uni-muenchen.de
authors.forename: D H
authors.initials: DH
authors.lastname: Boehm
authors.forename: H
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: H
authors.initials: H
authors.lastname: Gulbins
authors.forename: C
authors.initials: C
authors.lastname: Detter
authors.forename: B
authors.initials: B
authors.lastname: Meiser
authors.forename: P
authors.initials: P
authors.lastname: Brenner
authors.forename: H
authors.initials: H
authors.lastname: Habazettl
authors.forename: B
authors.initials: B
authors.lastname: Reichart
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004285:Dogs; D004724:Endoscopy; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation; D008955:Models, Cardiovascular; D009204:Myocardial Revascularization / Q000295:instrumentation; D012371:Robotics; D013523:Surgical Equipment; D013552:Swine; D013686:Telemetry / Q000295:instrumentation; D016896:Treatment Outcome