title: A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis.
abstract: BACKGROUND
  New technology has enabled surgeons to attempt totally endoscopic coronary artery bypass grafting. Our purpose was to compare three different techniques of totally endoscopic anastomosis using a porcine animal model.
  
  
  METHODS
  Porcine hearts were excised and the right coronary artery was dissected free for use as an arterial graft. The hearts were placed in a human thoracic model and an endoscopic arterial anastomosis between the free right coronary artery and the left anterior descending coronary artery was performed using one of the following: (1) two-dimensional visualization with straight endoscopic instruments (n = 8); (2) three-dimensional head-mounted visualization with curved endoscopic instruments (n = 7); or (3) three-dimensional visualization with robotic telemanipulation (n = 8). Pathologic analysis of suture placement, vessel trauma, and patency was performed. Anastomoses were graded according to quality, ease, and patency using a seven-point Likert scale (1 = excellent, 7 = very poor).
  
  
  RESULTS
  Endoscopic anastomotic ease and quality were significantly improved when three-dimensional visualization and curved endoscopic instruments were employed. Telemanipulation enhanced the process and provided the best operative results with regard to time required to construct the anastomosis, as well as ease and quality.
  
  
  CONCLUSIONS
  Totally endoscopic anastomosis is feasible using currently available technology. Three-dimensional visualization and robotic telemanipulation significantly facilitate anastomosis construction and will likely benefit clinical operative outcome.
authors.affiliation: Division of Cardiothoracic Surgery, London Health Sciences Centre, University of Western Ontario, Canada. douglas.boyd@lhsc.on.ca
authors.forename: W D
authors.initials: WD
authors.lastname: Boyd
authors.forename: N D
authors.initials: ND
authors.lastname: Desai
authors.forename: B
authors.initials: B
authors.lastname: Kiaii
authors.forename: R
authors.initials: R
authors.lastname: Rayman
authors.forename: A H
authors.initials: AH
authors.lastname: Menkis
authors.forename: F N
authors.initials: FN
authors.lastname: McKenzie
authors.forename: R J
authors.initials: RJ
authors.lastname: Novick
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D008953:Models, Anatomic; D012371:Robotics; D013552:Swine