title: The use of robotic technology in the LAST operation.
abstract: BACKGROUND
  The LAST operation represents a good option for single left anterior descending artery (LAD) revascularization. We report our preliminary experience with the LAST operation performed with the aid of the "da Vinci" Intuitive robotic system.
  
  
  METHODS
  From January 2000 to May 2001, 12 patients (11 males and 1 female, mean age 62 +/- 8 years) underwent the LAST operation. All patients had a proximal LAD lesion either not suitable for coronary angioplasty or unsuccessfully treated at coronary angioplasty previously. The mean preoperative ejection fraction was 55 +/- 5%. In all patients, left internal mammary artery (LIMA) harvesting was carried out endoscopically using robotic technology. After heparin administration the LIMA was distally divided to check the adequacy of the blood flow. An incision of about 6 cm was then made in the appropriate intercostal space and the LAD was exposed using a special costal retractor. Following the insertion of a temporary intracoronary shunt, the LIMA was anastomosed to the LAD.
  
  
  RESULTS
  No hospital or delayed death occurred. Uneventful conversion to midline sternotomy was necessary in one patient who developed ischemic changes and hemodynamic instability. One patient had a revision for postoperative bleeding. All patients were discharged within the first postoperative week and in 4 of them optimal patency of the LIMA graft was angiographically documented.
  
  
  CONCLUSIONS
  The use of robotic technology seems to overcome all the drawbacks associated with the LAST operation and enhances the role of minimally invasive surgery in coronary artery revascularization.
authors.affiliation: Division of Cardiac Surgery, San Raffaele Hospital, Milan, Italy. Lucia.Torracca@hsr.it
authors.forename: L
authors.initials: L
authors.lastname: Torracca
authors.forename: G
authors.initials: G
authors.lastname: Ismeno
authors.forename: V
authors.initials: V
authors.lastname: Franzè
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D003331:Coronary Vessels / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation*; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology