title: How to improve performance of robotic totally endoscopic coronary artery bypass grafting.
abstract: BACKGROUND
  We investigated whether specific surgical measures during the learning curve can influence procedural performance in robotic totally endoscopic coronary artery bypass grafting (TECAB).
  
  
  METHODS
  From 2001 to 2006, 70 patients underwent TECAB using the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, CA). The following measures were employed with the intent to improve procedure performance: (1) introduction of a fixed team of surgeons at case 14; (2) application of fibrin glue to seal the anastomosis at case 28; and (3) use of a fourth port for transthoracic assistance at case 49.
  
  
  RESULTS
  All 3 measures resulted in a reduction of operating room (OR) time (27%, 20%, and 20%). Use of a stable OR team and peri-anastomotic fibrin glue reduced the rate of conversions and on-table revisions from 39% to 9% (P = .006) and from 26% to 7% (P = .038), respectively. Peri-anastomotic fibrin glue significantly reduced postoperative revisions for bleeding. Using transthoracic assistance, anastomotic time was shortened from 35 minutes (range 23-67) to 25 minutes (range 16-100) (P < .001).
  
  
  CONCLUSIONS
  The 3 measures can improve intraoperative and clinical results in TECAB.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. johannes.o.bonatti@uibk.ac.at <johannes.o.bonatti@uibk.ac.at>
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Armin
authors.initials: A
authors.lastname: Oehlinger
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ruetzler
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives