On-Pump Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting: An Animal Study.
BACKGROUND
Total endoscopic coronary artery bypass grafting (TECAB) is currently performed exclusively with the help of a telemanipulator. After extensive practice in a biomechanical model, the operation was performed as a nonrobotic approach in an animal study.


METHODS
Six large domestic pigs were anesthetized and intubated. Port access and endoscopic vision were used exclusively during the intrathoracic procedure. In five animals, an internal mammary artery was harvested, extracorporeal circulation was established via peripheral vessel access, and the ascending aorta occluded with an intraluminal balloon. In cardioplegic arrest, an anastomosis of internal mammary artery and left anterior descending coronary artery was performed with shortened 7-0 monofil thread running suture. As a terminal study, the animals were humanely killed and the quality of the anastomoses was checked.


RESULTS
After a steady learning curve, the fifth animal was operated on successfully and a satisfactory anastomosis was documented.


CONCLUSIONS
Despite demanding differences to humans as shape of thoracic cavity and size of peripheral access vessels, the viability of the nonrobotic TECAB concept was documented in a living animal model.
Department of Cardiothoracic and Vascular Surgery, University Hospital, Ulm, Germany.
Hagen
H
Gorki
Department of Cardiothoracic and Vascular Surgery, University Hospital, Ulm, Germany.
Jun
J
Liu
Institute of Innovative Medicine, Beichlingen, Germany.
Frank
F
Poelzing
Department of Cardiology, Zentralklinik Bad Berka GmbH, Bad Berka, Germany.
Susanne D
SD
Gorki
Institute of Innovative Medicine, Beichlingen, Germany.
Heidi
H
Pasche
Department of Cardiothoracic and Vascular Surgery, University Hospital, Ulm, Germany.
Guenter
G
Albrecht
Department of Cardiothoracic and Vascular Surgery, University Hospital, Ulm, Germany.
Andreas
A
Liebold
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004195:Disease Models, Animal; D057510:Endovascular Procedures / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery / Q000637:transplantation*; D012371:Robotics; D013552:Swine