Defining the Learning Curve for Robotic-Assisted Endoscopic Harvesting of the Left Internal Mammary Artery

Hemli, Jonathan M.; Henn, Lucas W.; Panetta, Christopher R.; Suh, Jenny S.; Shukri, Scott R.; Jennings, Joan; Fontana, Gregory P.; Patel, Nirav

doi:10.1177/155698451300800506

Cited by 9 publications

(15 citation statements)

References 24 publications

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“…To define the LC for robot-assisted left internal mammary artery (LIMA) harvest, Hemli et al [7] analyzed the results of 77 robot-assisted minimally invasive CABG and noticed a decline in all time variables (instrument positioning time, mean LIMA harvest time, total robot time) with increasing surgical experience. This improvement was most visible within the first 15 cases.…”

Section: Cardiac Vessel Surgerymentioning

confidence: 99%

“…Acceptability of using certain variables as markers of learning varied between researchers. For example, although mortality post-CABG was quoted as an outcome variable in eight different LC studies [5][6][7][8]11,13,14], Caputo et al [10] deemed it unsuitable as a monitor of performance due to its rare incidence in the institution. Instead, they included perioperative death and 10 other operative complications to define a new variable, surgical failure.…”

Section: Outcome Variablesmentioning

confidence: 99%

“…Based on OT, which was the most common variable measured, the LC for CABG which included on-pump and offpump approaches ranged between 15 and 100 cases [4][5][6][7][8][9][10][11][12][13][14]; for endoscopic vessel harvesting, LCs lied between 20 and 35 cases [15,16]; for valvular surgery, which included valvular repair and valve replacement surgeries, LC were found to be between 20 and 135 cases [17][18][19][20][21][22][23][24][25][26][27]; for VATS, LCs were between 15 and 35 cases [28][29][30][31][32]; for vascular neurosurgical procedures, LCs were computed to be between 100 and 500 cases based on complications [37][38][39][40]; for endovascular vessel repairs, LCs were between 5 and 40 cases DOI: 10.1080/00325481.2014.996113…”

Section: Summary Of Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Arora

Khan

Abboudi

et al. 2014

Postgraduate Medicine

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LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.

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Section: Cardiac Vessel Surgerymentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

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Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Arora

Khan

Abboudi

et al. 2014

Postgraduate Medicine

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“…Our technique for robotic‐assisted LIMA to LAD bypass, constituting the MIDCAB component of HCR, has been described previously 13,14 . Briefly, the da Vinci Intuitive robot system (Intuitive Surgical Inc, Sunnyvale, CA) was utilized for LIMA harvest.…”

Section: Methodsmentioning

confidence: 99%

Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

et al. 2020

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Background Hybrid coronary revascularization (HCR) constitutes a left internal mammary artery graft to the left anterior descending (LAD) coronary artery, coupled with percutaneous coronary intervention (PCI) for non‐LAD lesions. This management strategy is not commonly offered to patients with complex multivessel disease. Our objective was to evaluate 8‐year survival in patients with triple‐vessel disease (TVD) treated by HCR, compared with that of concurrent matched patients managed by traditional coronary artery bypass grafting (CABG) or multivessel PCI. Methods A retrospective review was undertaken of 4805 patients with TVD who presented between January 2009 and December 2016. A cohort of 100 patients who underwent HCR were propensity‐matched with patients treated by CABG or multivessel PCI. The primary endpoint was all‐cause mortality at 8 years. Results Patients with TVD who underwent HCR had similar 8‐year mortality (5.0%) as did those with CABG (4.0%) or multivessel PCI (9.0%). A composite endpoint of death, repeat revascularization, and new myocardial infarction, was not significantly different between patient groups (HCR 21.0% vs CABG 15.0%, P = .36; HCR 21.0% vs PCI 25.0%, P = .60). Despite a higher baseline synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX) score, HCR was able to achieve a lower residual SYNTAX score than multivessel PCI (P = .001). Conclusions In select patients with TVD, long‐term survival and FREEDOM from major adverse cardiovascular events after HCR are similar to that seen after traditional CABG or multivessel PCI. HCR should be considered for patients with multivessel disease, presuming a low residual SYNTAX score can be achieved.

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“…Here, the telemanipulator is used for endoscopic harvesting of the LIMA avoiding traumatic asymmetric rib spreading followed by manual performance of anastomoses under direct vision via a minithoracotomy. 8,9 After extensive training in a biomechanical model, 10 in a porcine model 11 and in human body donors, a prospective clinical proof-of-concept study for nrTECAB was initiated. The revascularization LIMA to LAD was planned exclusively under endoscopic vision without telemanipulator.…”

mentioning

confidence: 99%

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

Gorki

Sabău

et al. 2018

Innovations�(Phila)

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Objective At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator (“robot”). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach. Methods Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases. Results In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting). Conclusions With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.

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Defining the Learning Curve for Robotic-Assisted Endoscopic Harvesting of the Left Internal Mammary Artery

Cited by 9 publications

References 24 publications

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Learning curves for cardiothoracic and vascular surgical procedures – a systematic review

Long‐term survival in triple‐vessel disease: Hybrid coronary revascularization compared to contemporary revascularization methods

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

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