Robotic endoscopic left internal mammary artery harvesting: what have we learned after 100 cases?
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.
Oehlinger
Armin
A
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. armin_oehlinger@gmx.at
Bonaros
Nikolaos
N
Schachner
Thomas
T
Ruetzler
Elisabeth
E
Friedrich
Guy
G
Laufer
Guenther
G
Bonatti
Johannes
J
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