title: Robotically assisted versus conventional freehand technique during beating heart anastomoses of left internal thoracic artery to left anterior descending artery.
abstract: BACKGROUND
  Although robotically assisted coronary arterial anastomoses are being performed clinically, the short-term and long-term quality and integrity of the left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis remains unknown. The goal of this study was to perform a histologic and angiographic assessment of porcine beating heart LITA to LAD anastomoses using either robotic assistance or a conventional freehand technique.
  
  
  METHODS
  Twelve pigs underwent beating heart LITA to LAD anastomoses using either the robotically assisted (n = 6) or conventional freehand techniques (n = 6). Quantitative histologic analysis was performed in all animals in order to determine the degree of vascular wall damage. Selective coronary arteriography was performed in all animals immediately after the procedure in order to evaluate anastomotic patency. The unpaired Student's t test was used for all comparisons between groups.
  
  
  RESULTS
  There were no differences in vascular wall damage between the robotically assisted and freehand techniques. Postoperative angiography revealed no stenoses in either group.
  
  
  CONCLUSIONS
  Use of the robotically assisted technique for creation of a LITA to LAD anastomosis was not associated with increased histologic damage when compared with the freehand technique in a beating heart porcine model. Furthermore, there was no difference between the two techniques in postoperative patency rate. These results support further clinical investigation of robotically assisted coronary bypass surgery.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Luis H
authors.initials: LH
authors.lastname: Diodato
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Domkowski
authors.forename: Monica L
authors.initials: ML
authors.lastname: Smith
authors.forename: Shankha S
authors.initials: SS
authors.lastname: Biswas
authors.forename: Ted
authors.initials: T
authors.lastname: Schwartz
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Landolfo
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D012371:Robotics; D013536:Suture Techniques; D013552:Swine; D013895:Thoracic Arteries / Q000637:transplantation*