Do manual assisting maneuvers increase speed and technical performance in robotically sutured coronary bypass graft anastomoses?
BACKGROUND
Robotic endoscopic coronary artery bypass grafting procedures usually are performed as solo surgery operations. This study aimed to investigate whether manual assistance can reduce suturing times and anastomotic suturing problems in robotic coronary artery surgery.


METHODS
In isolated pig hearts, the right coronary artery was excised from the epicardium as a pedicle. This pedicled vessel, which resembles the internal mammary artery, was sutured to the left anterior descending artery using the daVinci telemanipulation system. The anastomosis was performed in a running fashion using 7/0 Pronova. In group 1 (n = 20), the suture was performed by the console surgeon as a solo operation. In group 2 (n = 20), the anastomosis was assisted by a team member using an endo forceps. The operations were performed by five surgeons of different training levels.


RESULTS
The overall anastomotic time was 24 +/- 15 min in group 1 and 22 +/- 12 min in group 2. The difference was not significant. The rate for anastomotic suturing problems (thread rupture, knot formation, sling formation, needle bending) was 8 in 20 (40%) in group 1 and 8 in 20 (40%) in group 2 (no difference). Anastomotic times and anastomotic suturing errors were dependent on surgeon experience. All anastomoses in both groups showed correct suture alignment and were probe patent.


CONCLUSIONS
In a wet lab model of robotic coronary anastomoses, assisting maneuvers do not decrease suturing speed. Similar suturing quality can be achieved whether the suture is performed in a solo fashion or in an assisted manner.
Bonatti
J
J
Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020, Innsbruck, Austria. johannes.o.bonatti@i-med.ac.at
Alfadlhi
J
J
Schachner
T
T
Bonaros
N
N
Rützler
E
E
Laufer
G
G
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D012371:Robotics; D013536:Suture Techniques; D013552:Swine