Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery?
BACKGROUND
Minimimal access multivessel coronary artery bypass grafting with same day hospital discharge remains the ultimate goal. We evaluated the feasibility for achieving multivessel coronary bypass through minimal access.


METHODS
From January to July 2003, 30 patients under went off-pump minimally invasive multivessel coronary bypass. Internal mammary arteries were harvested with robotic telemanipulation with three ports. A 2-inch to 3-inch incision with soft tissue retractor was used to perform coronary anastomosis. Robotic ports were used to introduce stabilization and cardiac positioning devices. Endoscopic harvesting of radial artery was done when necessary.


RESULTS
Twenty-three patients (77%) had anterior throracotomy approach and 7 (23%) had transabdominal approach. Average number of bypass grafts was 2.6 (range 2-4). There was no mortality in hospital or on 30-day follow-up. Twenty-nine patients (97%) were extubated on the operating table. Two patients required reoperation for bleeding and 1 of those patients needed conversion to sternotomy for additional bypass grafting. Within 24 hours of surgery 50% of patients (n = 15) were discharged, 10% (n = 3) were discharged in 24 to 36 hours, 17% (n = 5) were discharged in 36 to 48 hours, 17% (n = 5) were discharged in 48 to 72 hours, and 2 patients stayed more than 3 days in the hospital. Two patients needed readmission to hospital within 30 days; 1 for pleural effusion and 1 for wound infection.


CONCLUSIONS
Robotic harvesting of internal mammary arteries and port access stabilization and cardiac positioning allows multivessel coronary bypass to be performed through a small incision. Currently, the majority of the patients can be safely discharged within 36 hours of operation.
Subramanian
Valavanur A
VA
Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York 10021, USA. vsubramanian@lenoxhill.net
Patel
Nilesh U
NU
Patel
Nirav C
NC
Loulmet
Didier F
DF
D000368:Aged; D000556:Ambulatory Surgical Procedures; D006348:Cardiac Surgical Procedures; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011187:Posture; D012086:Reoperation; D012371:Robotics; D020858:Tissue and Organ Harvesting / Q000379:methods