title: Endoscopic computer-enhanced beating heart coronary artery bypass grafting.
abstract: BACKGROUND
  Telemanipulation systems have enabled coronary revascularization on the arrested heart. The purpose of this study was to develop a technique for computer-enhanced endoscopic coronary artery bypass grafting on the beating heart.
  
  
  METHODS
  The operation was performed using the daVinci telemanipulation system. Through three ports, the left internal thoracic artery was harvested in 10 mongrel dogs (30 to 35 kg) using single right-lung ventilation and CO2 insufflation. Through a fourth port an articulating stabilizer, manipulated from a second surgical console, was inserted to stabilize the heart. The left anterior descending artery was snared using silicone elastomer slings anchored in the stabilizer cleats and the graft to coronary artery anastomosis was performed.
  
  
  RESULTS
  In 7 of 10 dogs, total endoscopic beating heart bypass grafting, cardiac stabilization, arteriotomy, and arterial anastomosis were performed using computer-enhanced technology. Endoscopic stabilization and temporary left anterior descending artery occlusion were well tolerated. All grafts were patent although minor strictures were found in 2. In 3 dogs, the procedure could not be completed (1 ventricular arrhythmia, 1 left atrial laceration, and 1 right ventricular outflow tract compression).
  
  
  CONCLUSIONS
  Endoscopic beating heart coronary artery bypass grafting is possible in a canine model using a computer-enhanced instrumentation system and articulating stabilization.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, California 94305, USA. vfalk@stanford.edu
authors.forename: V
authors.initials: V
authors.lastname: Falk
authors.forename: J I
authors.initials: JI
authors.lastname: Fann
authors.forename: J
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: D
authors.initials: D
authors.lastname: Daunt
authors.forename: T A
authors.initials: TA
authors.lastname: Burdon
mesh_terms: D000818:Animals; D003199:Computer Systems; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004285:Dogs; D005240:Feasibility Studies; D006801:Humans; D012371:Robotics / Q000295:instrumentation*; D013523:Surgical Equipment; D020708:Thoracoscopes