How to improve performance of robotic totally endoscopic coronary artery bypass grafting.
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.
Bonatti
Johannes
J
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. johannes.o.bonatti@uibk.ac.at <johannes.o.bonatti@uibk.ac.at>
Schachner
Thomas
T
Bonaros
Nikolaos
N
Oehlinger
Armin
A
Ruetzler
Elisabeth
E
Friedrich
Guy
G
Feuchtner
Gudrun
G
Laufer
Guenther
G
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
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives