title: Technique of closed chest coronary artery surgery on the beating heart.
abstract: OBJECTIVE
  The application of an endoscopic stabilizer (Intuitive Surgical, Mountain View, CA, USA) enables closed chest off-pump coronary artery bypass via a four-point stab incision avoiding sternotomy and minithoracotomy.
  
  
  METHODS
  Between May 1999 and January 2001 we operated upon a total of 37 patients (five female, 32 male, median age 62+/-9 years) suffering from coronary artery disease using totally endoscopic coronary artery bypass (TECAB), whereas an initial series of eight TECAB patients was operated upon using an endovascular bypass system (Heartport). The da Vinci surgical system was used in order to perform left internal mammary artery (LIMA) or right internal mammary artery (RIMA) harvesting and anastomoses on a beating heart in 29 patients (four female, 25 male, median age 64+/-9.8 years). Altogether 26 patients suffering from single-vessel coronary artery disease (SVCAD) were revascularized applying LIMA to the left anterior descending artery (LAD) and three patients with two diseased coronary vessels received bilateral internal mammary artery grafting (BIMA), respectively.
  
  
  RESULTS
  In this series we had a 100% survival rate. Conversion rate to a median sternotomy was 3.4%. Patients were operated upon via four 1-cm chest incisions using the da Vinci robot for LIMA or BIMA harvesting and for performance of anastomoses on the beating heart. In the overall series of 56 patients intended to be treated by TECAB, 19 (33.9%) were converted to a minimally invasive direct coronary artery bypass procedure.
  
  
  CONCLUSIONS
  This new robotic-enhanced surgical technique promotes an optimistic way of thinking about the further development of this procedure and its application in patients suffering from single-vessel CAD.
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307 Dresden, Germany. monika.weber.hkz_dd@t-online.de
authors.forename: U
authors.initials: U
authors.lastname: Kappert
authors.forename: R
authors.initials: R
authors.lastname: Cichon
authors.forename: J
authors.initials: J
authors.lastname: Schneider
authors.forename: V
authors.initials: V
authors.lastname: Gulielmos
authors.forename: T
authors.initials: T
authors.lastname: Ahmadzade
authors.forename: J
authors.initials: J
authors.lastname: Nicolai
authors.forename: S M
authors.initials: SM
authors.lastname: Tugtekin
authors.forename: S
authors.initials: S
authors.lastname: Schueler
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D009204:Myocardial Revascularization / Q000295:instrumentation; D012371:Robotics / Q000295:instrumentation*