title: Robotically assisted, completely endoscopic transmyocardial revascularization is feasible.
abstract: OBJECTIVE
  The purpose of this study was to assess the feasibility of an endoscopic, optical-fiber-based, laser delivery system (LDS) developed to perform sole-therapy transmyocardial revascularization (TMR) in a totally endoscopic, robotically assisted operation.
  
  
  METHODS
  Forty-two patients were enrolled in a multicenter, prospective, single-arm clinical trial conducted at four US centers between 2005 and 2007. Transmyocardial revascularization was performed completely endoscopically with robotic assistance, introducing the Holmium:Yttrium aluminum garnet (YAG) LDS via a 5-mm port. Completion of the operation endoscopically defined procedural success. Clinical data were recorded before, during, and at least 30 days after the procedure.
  
  
  RESULTS
  All patients had Canadian Cardiovascular Score angina class IV at baseline. The mean ejection fraction was 49% (range [R], 28-71), the mean age was 59.1 years (R, 36-80), 71% (30/42) were men, 86% (36/42) underwent previous coronary artery bypass grafting surgery, and 76% (32/42) underwent prior coronary stenting. Procedural success was accomplished in 93% (39/42). For the procedural successes, the mean number of TMR channels was 32 (R, 16-50), the median operative time was 88 minutes (R, 48-250 minutes), and the median length of stay postoperatively was 2.5 days (R, 1-10). There was no operative or 30-day mortality, and no patient received any transfusion. At 30 days, freedom from major adverse cardiac events was 95% (two patients had transient congestive heart failure). At the median 6-month follow-up (single-center data, n = 12), the mean (SD) Canadian Cardiovascular Score angina score was 1.3 (0.05) (P < 0.001 vs baseline).
  
  
  CONCLUSIONS
  Robotically assisted TMR can be performed using an endoscopic, optical-fiber-based LDS, with high procedural success, avoidance of early adverse clinical events, and potential for successful angina relief.
authors.affiliation: From the *Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL USA; †St. Joseph's Hospital, Atlanta, GA USA; ‡Akron City Hospital, Akron, OH USA; and §The International Centre for Robotic Surgery, New Delhi, India.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Brunsting
authors.forename: Averel B
authors.initials: AB
authors.lastname: Snyder
authors.forename: Eric A
authors.initials: EA
authors.lastname: Espinal
authors.forename: Sudhir P
authors.initials: SP
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000601:surgery*; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D065287:Robotic Surgical Procedures