Background. Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. Methods. A computer-enhanced surgical telemanipulation system was used to perform transabd...
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Background. Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. Methods. A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left (n = 10) and right internal thoracic arteries (n = 5) was performed. Coronary anastomoses were performed remotely and unassisted. In an animal model the hemodynamic consequences of the approach were assessed. Results. In all cadavers TCAB was achieved through three abdominal ports. Time for internal thoracic arteries harvest was 48 +/- 13 minutes (left) and 39 +/- 10 minutes (right). Intimal dissection was found in one graft. Time for anastomosis was 23 +/- 9 minutes and 27 +/- 10 minutes for the left anterior descending (n = 10) and right coronary artery (n = 5), respectively. All anastomoses were patent. Opening the diaphragm in living animals led to a decrease of systolic blood pressure by 30 +/- 16 mm Hg, but resolved with appropriate treatment. Conclusions. TCAB is possible in cadavers using computer-enhanced telemanipulation technology. The transabdominal approach is a promising access for less invasive cardiac surgery. (C) 1999 by The Society of Thoracic Surgeons.
Background. To achieve an endoscopic coronary bypass anastomoses we performed a study with endoscopic robotic instrumentation and camera guidance using three-dimensional (3-D) visualization. Methods. The surgical robo...
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Background. To achieve an endoscopic coronary bypass anastomoses we performed a study with endoscopic robotic instrumentation and camera guidance using three-dimensional (3-D) visualization. Methods. The surgical robotic system ZEUS (Computer Motion Inc, Goleta, CA) consists of three interactive robotic arms and a control unit allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion Inc, Goleta, CA) positions the endoscope via voice control. The study had three phases. Phase I: In a phantom model, end-to-side anastomoses between vein grafts and the left anterior descending coronary artery (LAD) of 109 pig hearts were performed. Phase II: In 6 dogs (FBI, 20-25 kg) the left internal mammary artery (LIMA) was harvested endoscopically. During Port-Access (Heartport Inc, Redwood City, CA) cardiopulmonary bypass (CPB), LIMA and LAD were then anastomosed endoscopically with the help of telemetric ZEUS instruments (Computer Motion Int). Phase III: A total of seven patients were operated on with help of the ZEUS system (Computer Motion Inc), After endoscopic LIMA harvesting and CPB using the Port-Access (Heartport Inc) system, the bypass graft (LIMA to LAD) was anastomosed endoscopically through three thoracic ports in 2 patients. Another 3 patients were operated on off-pump with regional stabilization and 2 patients with sternotomy and routine CPB. Results. The practice with the phantom model and the subsequent animal experiments allowed the surgeons to gain sufficient experience for the clinical setting. In the clinical cases, times for anastomoses ranged from 20 to 42 minutes. Median internal mammary artery how rate was 74 mt, per minute (range 36-110 mL per minute). One patient in the off-pump group was converted to CPB and routine anastomosis. All patients had an uneventful angiographic control and postoperative course. Conclusions. Using telemetic technology, a completely endoscopic anastomosis elf LIMA to LAD is pos
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