title: Experiences in robotically enhanced IMA-preparation as initial step towards totally endoscopic coronary artery bypass grafting.
abstract: OBJECTIVE
  To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA).
  
  
  METHODS
  Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO(2) insufflation and single lung ventilation using electrocautery.
  
  
  RESULTS
  In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7+/-1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7+/-21.1 and 99.2+/-8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9+/-13.1 s, clip applier 72.8+/-28.4 s).
  
  
  CONCLUSIONS
  Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.
authors: Clinic for Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland. oliver.reuthebuch@chi.usz.ch
authors: O
authors: O
authors: Reuthebuch
authors: M
authors: M
authors: Comber
authors: J
authors: J
authors: Grünenfelder
authors: G
authors: G
authors: Zünd
authors: M
authors: M
authors: Turina
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation / Q000379:methods*; D007431:Intraoperative Complications; D007432:Intraoperative Period; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*