Technical aids to performing thoracoscopic robotically-assisted internal mammary artery harvesting.
OBJECTIVE
This report outlines the procedures and technical aids used for performing thoracoscopic internal mammary artery (IMA) harvesting in a series of 308 patients.


METHODS
As a part of atraumatic coronary artery bypass (ACAB) operations, thoracoscopic IMA harvests (294 left, 14 right, and 12 bilateral) were performed in 308 consecutive patients. Single-lung ventilation and carbon dioxide insufflation were employed in all cases to facilitate exposure and dissection. A voice-activated robotic arm controlled the camera view, and harvesting was accomplished with the electrocautery on a low setting.


RESULTS
Harvest time decreased from a mean of 58.4 minutes in the first fifty procedures to 29.4 minutes in the last fifty procedures. There were no significant complications as a result of this technique, and no patients required a conversion to sternotomy as a result of IMA injury.


CONCLUSIONS
Thoracoscopic internal mammary artery harvesting is an essential basic skill for cardiac surgeons interested in performing minimally invasive and atraumatic coronary bypass procedures. Thoracoscopic IMA harvesting can be successfully performed with the use of the technical aids and procedures outlined in this report.
Pensacola Heart Institute, Pensacola, Florida, USA. vassiliades@pol.net
Thomas A
TA
Vassiliades
D006801:Humans; D007327:Insufflation; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D012371:Robotics / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D013906:Thoracoscopy; D016896:Treatment Outcome