Robotic-enhanced Dresden technique for minimally invasive bilateral internal mammary artery grafting.
BACKGROUND
The introduction of robotic-enhanced endoscopic instrumentation systems allows the surgeon to perform arterial revascularization for multivessel coronary artery disease without sternotomy.


METHODS
From April 1999, 27 patients (6 female, 21 male, median age 63 +/- 8.2 years) suffering from multivessel coronary artery disease were treated surgically using arterial revascularization by means of bilateral internal mammary artery (BIMA) grafting. Both arteries were harvested totally endoscopically using the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA). These vessels were anastomosed using the "Dresden Technique" via a left minithoracotomy in the second intercostal space.


RESULTS
All patients survived the operation. The mean duration of surgery was 240 +/- 79.4 minutes. Bilateral internal mammary artery harvesting time was 88.5 +/- 15.9 minutes, and cross-clamp time was 38 +/- 10.9 minutes. An average of 2.07 anastomoses were performed per operation. Postoperatively, the patients remained in ICU for 20 +/- 2.4 hours. One patient needed reexploration due to bleeding.


CONCLUSIONS
Bilateral internal mammary artery harvesting can be achieved safely with the use of wrist-enhanced instrumentation. The robotic surgical system introduces into surgical practice a new type of treatment of coronary artery disease, helping to perform arterial revascularization with a distinctly reduced surgical trauma.
Kappert
U
U
Department of Cardiac Surgery, Department of Anesthesiology; Cardiovascular Institute, University of Dresden, Germany.
Cichon
R
R
Gulielmos
V
V
Schneider
J
J
Schramm
I
I
Nicolai
J
J
Tugtekin
S M
SM
Schueler
S
S
D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D012371:Robotics; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency