Optimization of vessel orientation for robotic coronary artery bypass grafting.
The availability of telemanipulation robots has not yet resulted in the emergence of a reliable endoscopic coronary bypass procedure. A major challenge in performing a closed-chest coronary operation is creating a high-quality anastomosis in a reasonable period of time. In this experimental study, the impact of distal vessel orientation on the speed and accuracy of anastomosis was quantifed. We found that vessel orientation and the relative angle of the surgical plane influence anastomosis speed, the trauma to the vessel, the accuracy of stitch placement, and the eventual achievement of hemostasis. Our results suggest that the speed and accuracy of a robotically performed anastomosis of a vessel graft to a coronary artery can be improved by making small changes in vessel orientation. Vessels should be positioned between the horizontal and diagonal orientation and inclined between the horizontal and +45 degrees . Because the 6-o'clock stitch is particularly challenging, surgeons may benefit from an orientation that moves the heel or the toe of the anastomosis away from this critical position.
Recanati
Maurice-Andre
MA
Cardiac Surgical Unit, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Agnihotri
Arvind K
AK
White
Jennifer K
JK
Titus
James
J
Torchiana
David F
DF
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D006801:Humans; D008955:Models, Cardiovascular; D009339:Needles; D012371:Robotics; D013536:Suture Techniques / Q000295:instrumentation