title: Anatomy-based eligibility measure for robotic-assisted bypass surgery.
abstract: OBJECTIVE
  Robotic-assisted endoscopic single-vessel small thoracotomy allows clinicians to perform coronary artery bypass grafting surgery in a minimally invasive manner using the da Vinci Surgical System. Not all patients are suitable for this technique, and the lack of an appropriate method for patient eligibility avoids completion of the procedure robotically. The objective of this study was to develop a patient eligibility method based on the anatomy of the chest of the patient.
  
  
  METHODS
  Preoperative computed tomography thorax scans of 110 patients were analyzed. Two-dimensional measurements taken on the axial images were used with the goal of finding a relation between the anatomy of the patient and the completion of the procedure robotically.
  
  
  RESULTS
  Patients with a distance from the left anterior descending coronary artery to the anterior chest wall of smaller than 15 mm have a 20% probability of requiring conversion of the procedure to open surgery. This probability increases if the chest of the patient is very elliptical, having an anterior-posterior dimension of less than 45% of the transverse dimension.
  
  
  CONCLUSIONS
  The smaller the distance is from the left anterior descending artery to the anterior chest wall, the lower the chances are of completing the procedure robotically.
authors.affiliation: From the *Canadian Surgical Technologies & Advanced Robotics (CSTAR), Lawson Health Research Institute; and †Department of Electrical and Computer Engineering, ‡Department of Surgery, §Department of Medical Imaging, and ∥Division of Cardiac Surgery, Department of Surgery, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Abelardo
authors.initials: A
authors.lastname: Escoto
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Trejos
authors.forename: Rajni V
authors.initials: RV
authors.lastname: Patel
authors.forename: Aashish
authors.initials: A
authors.lastname: Goela
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
mesh_terms: D061887:Conversion to Open Surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011446:Prospective Studies; D013902:Radiography, Thoracic; D065287:Robotic Surgical Procedures; D013909:Thorax / Q000033:anatomy & histology*