title: Ongoing procedure development in robotically assisted totally endoscopic coronary artery bypass grafting (TECAB).
abstract: BACKGROUND
  Totally endoscopic coronary artery bypass grafting (TECAB) using robotics requires stepwise introduction into a heart surgery program. It is the aim of this study to evaluate the state of procedure development after continued application of telemanipulation techniques in the clinical setting. We also sought to assess perioperative and intermediate term clinical results after robotically assisted CABG.
  
  
  METHODS
  From June 2001 to March 2005, robotically assisted CABG using the daVinci system was carried out in 107 patients with single and multi-vessel coronary artery disease. The following procedures were performed: robotically assisted endoscopic left internal mammary artery (LIMA) harvesting and completion of the procedure as conventional CABG, MIDCAB, or OPCAB (n = 22), robotically assisted suturing of LIMA-to-LAD anastomoses during conventional CABG (n = 28), TECAB on the arrested heart using remote access perfusion (n = 48), TECAB on the beating heart using an endostabilizer (n = 8), takedown of adhesions (TECAB intended) (n = 1).
  
  
  RESULTS
  Hospital mortality was 0% and cumulative risk adjusted mortality reached 1.6 lives saved versus EuroSCORE predictions. Undesirable surgical events (USE) such as conversion, on table revision, or postoperative revision procedures occurred in 34 out of 107 (32%) patients. Median ventilation time and ICU stay, however, were 11(0-278) hours and 21(11-389) hours, respectively. Cumulative 3 years survival was 100% and freedom from angina at 3 years was 97%.
  
  
  CONCLUSIONS
  We conclude that despite being surgically challenging robotically assisted coronary artery surgery can be implemented with acceptable safety. TECAB procedures have reached a reproducible state. Perioperative mortality after robotically assisted CABG may be lower than predicted. Intermediate term clinical results are very satisfactory.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. johannes.o.bonatti@uibk.ac.at
authors.forename: J
authors.initials: J
authors.lastname: Bonatti
authors.forename: T
authors.initials: T
authors.lastname: Schachner
authors.forename: N
authors.initials: N
authors.lastname: Bonaros
authors.forename: A
authors.initials: A
authors.lastname: Oehlinger
authors.forename: M
authors.initials: M
authors.lastname: Danzmayr
authors.forename: E
authors.initials: E
authors.lastname: Rützler
authors.forename: O
authors.initials: O
authors.lastname: Bernecker
authors.forename: J
authors.initials: J
authors.lastname: Margreiter
authors.forename: C
authors.initials: C
authors.lastname: Velik-Salchner
authors.forename: G
authors.initials: G
authors.lastname: Friedrich
authors.forename: P
authors.initials: P
authors.lastname: Jonetzko
authors.forename: G
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012371:Robotics / Q000379:methods*