Initial United States clinical trial of robotically assisted endoscopic coronary artery bypass grafting.
OBJECTIVE
With traditional instruments, endoscopic coronary artery bypass grafting has not been possible. This study was designed to determine the clinical feasibility of using a robotically assisted microsurgical system to create endoscopic coronary anastomoses.


RESULTS
Ten patients underwent endoscopic coronary artery bypass grafting of the left internal thoracic artery to the left anterior descending artery. Subxiphoid endoscopic ports (2 for instruments, 1 for a camera) were placed, and a robotic system was used to perform the left internal thoracic artery-left anterior descending artery bypass graft. Conventional techniques were used to perform the other grafts. Blood flow through the left internal thoracic artery graft was measured in the operating room and was adequate in 8 of 10 patients. The 2 inadequate grafts were revised successfully by hand. Six weeks after the operation, selective coronary angiography demonstrated a graft patency of 100% (8/8). There were no technical failures of the robotic system. The only postoperative complication was mediastinal hemorrhage in 1 patient.


CONCLUSIONS
This pilot study demonstrates the feasibility of robotically assisted endoscopic coronary artery bypass grafting.
Damiano
R J
RJ
Division of Cardiothoracic Surgery, The Milton S. Hershey Medical Center, Hershey, PA, USA. rdamiano@psghs.edu
Ehrman
W J
WJ
Ducko
C T
CT
Tabaie
H A
HA
Stephenson
E R
ER
Kingsley
C P
CP
Chambers
C E
CE
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013895:Thoracic Arteries / Q000637:transplantation; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency