title: RAVECAB: improving outcome in off-pump minimal access surgery with robotic assistance and video enhancement.
abstract: OBJECTIVE
  To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA).
  
  
  METHODS
  A case series.
  
  
  METHODS
  London Health Sciences Centre, University of Western Ontario, London, Ont.
  
  
  METHODS
  Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting.
  
  
  METHODS
  Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant.
  
  
  METHODS
  Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization.
  
  
  RESULTS
  RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days.
  
  
  CONCLUSIONS
  RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.
authors.affiliation: London Health Sciences Centre, University of Western Ontario. douglas.boyd@lhsc.on.ca
authors.forename: W D
authors.initials: WD
authors.lastname: Boyd
authors.forename: B
authors.initials: B
authors.lastname: Kiaii
authors.forename: R J
authors.initials: RJ
authors.lastname: Novick
authors.forename: R
authors.initials: R
authors.lastname: Rayman
authors.forename: S
authors.initials: S
authors.lastname: Ganapathy
authors.forename: W B
authors.initials: WB
authors.lastname: Dobkowski
authors.forename: G
authors.initials: G
authors.lastname: Jablonsky
authors.forename: F N
authors.initials: FN
authors.lastname: McKenzie
authors.forename: A H
authors.initials: AH
authors.lastname: Menkis
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D012371:Robotics; D013895:Thoracic Arteries; D013906:Thoracoscopy; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D014741:Video Recording