title: Prospective angiographic comparison of direct, endoscopic, and telesurgical approaches to harvesting the internal thoracic artery.
abstract: BACKGROUND
  The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques.
  
  
  METHODS
  One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency.
  
  
  RESULTS
  Average left internal thoracic artery harvest times were 23 +/- 2.5, 63.3 +/- 20.3, and 66.1 +/- 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 +/- 11.9, 33.7 +/- 19.3, and 36.9 +/- 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall).
  
  
  CONCLUSIONS
  The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.
authors.affiliation: Department of Surgery, London Health Science Center, The University of Western Ontario, London, Ontario, Canada. bob.kiaii@lhsc.on.ca
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClure
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.forename: Reiza
authors.initials: R
authors.lastname: Rayman
authors.forename: Wojciech B
authors.initials: WB
authors.lastname: Dobkowski
authors.forename: George
authors.initials: G
authors.lastname: Jablonsky
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Boyd
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011859:Radiography; D012371:Robotics