title: Initial experience with internal mammary artery harvesting with the da Vinci Surgical System for minimally invasive direct coronary artery bypass.
abstract: OBJECTIVE
  We evaluated the feasibility of off-pump minimally invasive direct coronary artery bypass (MIDCAB) in combination with robotic harvesting of the left internal mammary artery (LIMA).
  
  
  METHODS
  Since 2004, 33 patients [average age, 64 years; 27 males (82%)] have undergone MIDCAB with robotic LIMA harvesting performed through the fourth or fifth intercostal space with guidance by enhanced computed tomography (CT).
  
  
  RESULTS
  No deaths or major adverse cardiac events occurred. Robotic LIMA harvesting was completed in 30 cases (91%), while three cases (9%) required conversion to a median sternotomy due to bleeding. The risk of LIMA injury significantly increased with age (p = 0.0012). For the 30 successful cases, the average harvest time was 68 min, and the average intraoperative blood loss was 306 ml, with only three patients (9%) requiring a transfusion. The graft flow was measurable in all cases (average, 34 ml/minute). All grafts were shown to be patent in postoperative evaluations, although CT revealed that the LIMA in one patient was anastomosed to an untargeted artery.
  
  
  CONCLUSIONS
  Off-pump MIDCAB in combination with robotic harvesting of the LIMA is a reasonable and less invasive procedure than the standard procedures. Potential problems include difficulty controlling bleeding from the graft, especially in elderly patients, and proper identification of the target artery.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan, tomofujita@nifty.com.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery* / Q000637:transplantation*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome