Training surgeons to perform robotically assisted totally endoscopic coronary surgery.
BACKGROUND
Robotic totally endoscopic coronary bypass (TECAB) surgery was developed during the past decade, and younger surgeons need to be trained in this new modality. This study assessed the learning curves and independent TECAB performance of 2 junior surgeons undergoing TECAB training.


METHODS
Two surgeons in training performed portions of 44 of 239 robotic TECAB operations, including left (LIMA) and right interior mammary artery (RIMA) harvesting, lipectomy, pericardiotomy, and IMA to left anterior descending coronary artery (LAD) anastomotic suturing.


RESULTS
The procedure portions performed faster by the senior surgeon vs trainees were, in minutes (range), lipectomy, 5 (2 to 18) vs 10 (5 to 21; p < 0.001); pericardiotomy, 5 (1 to 21) vs 7 (3 to 16; p = 0.001); RIMA takedown, 35 (25 to 48) vs 49 (40 to 55; p = 0.034); and LIMA to LAD anastomosis, 26 (12 to 100) vs 34 (24 to 67; p = 0.043). After assuming senior roles in the robotic cardiac surgery program, the 2 trained surgeons performed 14 TECABs (LIMA to LAD) without the senior surgeon. Lipectomy took 5 (3 to 8) minutes; pericardiotomy, 5 (2 to 10) minutes; LIMA takedown, 43 (27 to 70) minutes; LIMA to LAD anastomosis, 24 (15 to 60) minutes, cardiopulmonary bypass time, 73 (40 to 126) minutes; and aortic endo-occlusion time, 53 (0 to 83) minutes. No hospital deaths occurred.


CONCLUSIONS
TECAB can be well taught with a stepwise training program involving portions of the procedure performed by trainees. With such an approach, independent performance after training can be within adequate time limits and yields seemingly acceptable results.
Schachner
Thomas
T
Innsbruck Medical University, Innsbruck, Austria. thomas.schachner@i-med.ac.at
Bonaros
Nikolaos
N
Wiedemann
Dominik
D
Weidinger
Felix
F
Feuchtner
Gudrun
G
Friedrich
Guy
G
Laufer
Guenther
G
Bonatti
Johannes
J
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000193:education* / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery / Q000637:transplantation; D008875:Middle Aged; D010492:Pericardiectomy; D012371:Robotics / Q000193:education*; D020858:Tissue and Organ Harvesting / Q000379:methods