title: Totally endoscopic bilateral internal thoracic artery bypass grafting in a young diabetic patient.
abstract: BACKGROUND
  The introduction of robotics into cardiosurgical practice in 1998 has enabled totally endoscopic closed chest procedures. Totally endoscopic grafting of the LAD (TECAB) is no longer an experimental procedure.
  
  
  METHODS
  We report on a case with totally endoscopic bilateral internal thoracic artery bypass grafting to the left anterior descending and right coronary artery in a 36-year-old obese female diabetic patient using the daVinci surgical system. The patient, suffering from juvenile diabetes for 26 years, presented with stable angina (CCS class II). A coronary angiogram revealed 2-vessel disease with a long complex proximal lesion of the left anterior descending artery (LAD) (90%) and 80% stenosis of the proximal right coronary artery (RCA). Due to the condition of the proximal LAD (high risk PTCA with rather poor prognosis), the patient was referred for minimally invasive operative revascularisation of the LAD and the RCA. After informed consent was obtained the patient underwent totally endoscopic double internal thoracic artery bypass revascularisation on the arrested heart using computer-enhanced telemanipulation technology.
  
  
  RESULTS
  The feasibility and safety of successful closed chest, totally endoscopic double coronary bypass grafting with two internal thoracic arteries is demonstrated in this case. Preservation of a stable chest cavity and reduced risk for wound healing complications in diabetics with an excellent cosmetic result are the obvious advantages of the techniques described.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. S.Dogan@em.uni-frankfurt.de
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Khan
authors.forename: Gerd
authors.initials: G
authors.lastname: Neidhart
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Auch-Schwelk
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004724:Endoscopy; D005260:Female; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation*; D011859:Radiography; D012371:Robotics