title: Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery.
abstract: OBJECTIVE
  The influence of patient thoracic anatomy on operative times in robotic total endoscopic coronary artery bypass (TECAB) has not been well described. The aim of this study was to determine whether patient anatomy correlates with intraoperative time required to complete various procedural steps and overall operative time in TECAB.
  
  
  METHODS
  Preoperative multislice computed tomographic scans of the chest from 107 consecutive patients who underwent single-vessel TECAB were reviewed to measure a series of thoracic dimensions and relations. Measurements were correlated with time to complete various intraoperative procedural tasks as well as overall operative time.
  
  
  RESULTS
  There was a significant correlation between left internal mammary artery (LIMA) harvest time and depth of subcutaneous tissue at the level of the nipple (r = 0.24, P = 0.018). Pericardial fat pad thickness was associated with longer resection times (r = 0.266, P = 0.008). LIMA to left anterior descending artery anastomotic time was inversely correlated with the distance from the left heart border to the chest wall (r = -0.241, P = 0.016). Total operative time was also inversely correlated with this distance (r = -0.275, P = 0.005).
  
  
  CONCLUSIONS
  Anatomical measurements made on preoperative computed tomography in patients undergoing robotic TECAB can predict time requirements for various procedural steps. A shorter distance between the chest wall and the heart predicts longer anastomotic and total operative times. This information could assist the TECAB surgeon with surgical planning and help guide the TECAB trainee in patient selection.
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA bwehman@smail.umaryland.edu.
authors.forename: Brody
authors.initials: B
authors.lastname: Wehman
authors.affiliation: Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, WA, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lehr
authors.affiliation: Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Kian
authors.initials: K
authors.lastname: Lahiji
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Jeffry D
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.affiliation: Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Jeudy
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D061646:Operative Time; D018579:Patient Selection; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anatomy; CABG; CAT scan; Computed tomography; Coronary artery bypass grafts; Outcomes (includes mortality; Robotics (includes applications and related subject matter); etc); morbidity; survival