title: Toward totally endoscopic coronary artery surgery.
abstract: BACKGROUND
  Here we explore a method of using robotics to reduce morbidity and mortality in conventional coronary surgery.
  
  
  METHODS
  Using a robotic surgical system two surgeons completed five steps: (1) 80 synthetic suture exercises; (2) 76 left internal thoracic artery to left anterior descending (LIMA-to-LAD) on porcine hearts; (3) cadaveric port placement for assessing optimal access; (4) endoscopic stabilization in the live porcine model; and, finally (5) eight clinical LIMA-to-LADs performed robotically.
  
  
  RESULTS
  After 70 hours training, mean dry lab times fell from 7.0 and 5.8 min to 5.7 and 5.1 min in the two surgeonstab series. Wet lab times fell from 40.1 and 28.5 min to 28.8 and 19.2 min. In the clinical series of eight patients there were no mortalities; all had uncomplicated postoperative recovery and all were angina free at 6-week follow-up.
  
  
  CONCLUSIONS
  The learning curve for robotic training is short, and reproducible results can be achieved clinically, after appropriate training, resulting in real patient benefit.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK.
authors.forename: R H J
authors.initials: RH
authors.lastname: Trimlett
authors.forename: A C
authors.initials: AC
authors.lastname: De Souza
authors.forename: A S
authors.initials: AS
authors.lastname: Coonar
authors.forename: K M
authors.initials: KM
authors.lastname: Jurgens
authors.forename: R
authors.initials: R
authors.lastname: Kuenzler
authors.forename: J R
authors.initials: JR
authors.lastname: Pepper
mesh_terms: D000818:Animals; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D007858:Learning; D015203:Reproducibility of Results; D012371:Robotics; D013536:Suture Techniques; D013552:Swine; D013997:Time Factors