title: Robotic endoscopic left internal mammary artery harvesting: what have we learned after 100 cases?
abstract: BACKGROUND
  The development of robotic devices has recently offered the possibility of performing coronary artery bypass graft surgery (CABG) in a totally endoscopic way. An important step of this procedure is endoscopic harvesting of the left internal mammary artery (LIMA). It was the aim of our study to find factors influencing LIMA harvesting time and to describe the challenges associated with robotic endoscopic LIMA harvesting.
  
  
  METHODS
  From June 2001 to December 2005, a total of 100 patients underwent robotically assisted CABG. In all cases, the LIMA was harvested by using the robotic DaVinci device. Coronary artery bypass grafting procedures were completed through sternotomy, minithoracotomy, or in a totally endoscopic fashion.
  
  
  RESULTS
  The median LIMA harvesting time was 48 minutes (19 to 180). A significant learning curve was observed: y (min) = 151 - 26 x ln (x), x = LIMA takedown number, p less than 0.001. Takedown time decreased from 140 minutes in the first 10 cases to 34 minutes in the last 10 cases. There was no independent demographic factor that significantly influenced the LIMA harvesting time. The LIMA takedown time also showed no significant correlation with thorax dimensions. Injury to the LIMA occurred in 3 patients (6%) during the first half of the experience and in 1 patient (2%) during the second half (p = not significant).
  
  
  CONCLUSIONS
  Robotic-enhanced LIMA takedown is a prerequisite for totally endoscopic CABG. After passing through a significant learning curve, IMA takedown can be performed safely and within an acceptable time frame. Demography and chest size do not seem to influence IMA harvesting time. The rate of LIMA injuries is within the limits of conventional thoracoscopic harvesting.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. armin_oehlinger@gmx.at
authors.forename: Armin
authors.initials: A
authors.lastname: Oehlinger
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ruetzler
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D004564:Electrocoagulation / Q000009:adverse effects; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D012371:Robotics; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome