title: Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.
abstract: Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 +/- 17.9 minutes, 28.5 +/- 28.2 minutes, and 368 +/- 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
authors.affiliation: Department of Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Boyd
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kodera
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Stahl
authors.forename: Reiza
authors.initials: R
authors.lastname: Rayman
mesh_terms: D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D005544:Forecasting; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D012371:Robotics / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods / Q000639:trends*