Robotically assisted endoscopic transmyocardial laser revascularization.
BACKGROUND
The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been approved for the treatment of angina in inoperable patients, but it has had limited use as a stand-alone procedure.


OBJECTIVE
To assess the feasibility and efficacy of robotically assisted endoscopic TMR using the Zeus robotic surgical system (Computer Motion, USA) and an excimer TMR system (Spectranetics, USA) in a porcine model.


METHODS
Five pigs weighing 20 kg to 40 kg were used. A 10 mm endoscope, two 5 mm instrument ports and a 1.4 mm TMR probe were introduced into the left hemithorax. Endoscopic TMR was performed on the anterolateral or lateral left ventricular wall using Zeus instruments to hold and guide the TMR probe.


RESULTS
The mean system set-up time was 4.2+/-0.6 min, the mean port placement time was 11+/-1.7 min, the mean TMR procedure time was 5.0+/-0.7 min and the mean number of transmural TMR channels was 10+/-3.6. All pigs tolerated the entire procedure. Histological examination showed that transmural channels were successfully created.


CONCLUSIONS
Endoscopic TMR using the Zeus system was feasible, in a pig model, in creating transmural laser channels on the anterior and lateral left ventricle, and may provide a significant advantage over the open chest approach in reducing perioperative morbidity and improving recovery.
Izutani
Hironori
H
Deparment of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44109, USA.
Gill
Inderjit S
IS
Svanidze
Oleg
O
D000818:Animals; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D053685:Laser Therapy / Q000295:instrumentation* / Q000379:methods*; D023421:Models, Animal; D008955:Models, Cardiovascular; D009204:Myocardial Revascularization / Q000295:instrumentation* / Q000379:methods*; D010496:Pericardium / Q000601:surgery; D012371:Robotics; D013552:Swine; D016896:Treatment Outcome