title: Endoscopic internal thoracic artery dissection leads to significant reduction of pain after minimally invasive direct coronary artery bypass graft surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate postoperative pain levels after endoscopic versus conventional internal thoracic artery (ITA) dissection for minimally invasive direct coronary artery bypass graft surgery (MIDCABG) surgery. Results were compared with pain levels associated with conventional cardiac bypass operations through a median sternotomy.
  
  
  METHODS
  Of 190 patients included in this prospective study, 24 patients had endoscopic ITA takedown (MIDCABG-endo) using the da Vinci telemanipulator followed by a manual coronary anastomosis through a left minithoracotomy. A conventional MIDCABG operation (MIDCABG-conv) was performed in 73 patients with ITA preparation under direct vision. Postoperative pain levels after conventional CABG through a median sternotomy (CABG-conv, n = 93) served as controls. A standarized questionnaire including visual analog scale (VAS) was used for prospective pain assessment from POD 1 to 7.
  
  
  RESULTS
  Pain levels (VAS) declined in all groups from POD 1 to 7. Overall pain levels were significantly lower in the MIDCABG-endo group as compared with MIDCABG-conv and CABG-conv groups, respectively (p < 0.001, general linear model). There was no significant difference between the MIDCABG-conv and CABG-conv (p = not significant, general linear model) groups. Furthermore, patients after MIDCABG-endo required fewer nonsteroidal anti-inflammatory drugs and opioid medications, postoperatively.
  
  
  CONCLUSIONS
  An endoscopic ITA takedown in MIDCABG surgery leads to significantly reduced postoperative pain levels possibly because of less rib retraction.
authors: Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany. bucerj@medizin.uni-leipzig.de
authors: Jan
authors: J
authors: Bucerius
authors: Sebastian
authors: S
authors: Metz
authors: Thomas
authors: T
authors: Walther
authors: Volkmar
authors: V
authors: Falk
authors: Nicolas
authors: N
authors: Doll
authors: Frank
authors: F
authors: Noack
authors: David
authors: D
authors: Holzhey
authors: Anno
authors: A
authors: Diegeler
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D012371:Robotics