Five Hundred Cases of Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Predictors of Success and Safety

Bonaros, Nikolaos; Schachner, Thomas; Lehr, Eric J.; Kofler, Markus; Wiedemann, Dominik; Hong, Patricia; Wehman, Brody; Zimrin, David; Vesely, Mark; Friedrich, Guy; Bonatti, Johannes

doi:10.1016/j.athoracsur.2012.09.071

Cited by 134 publications

(106 citation statements)

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“…One study provided separate data for both the TECAB offpump and robotic MIDCAB groups, and was included for analysis in both groups (10). Eighteen additional studies reported on a mixture of different surgical techniques (18,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53). A summary of the study selection process is presented in the PRISMA chart in Figure 1, and a summary of study characteristics is presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies were excluded from the final analysis due to a mixed dataset for different surgical techniques (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) or use of cardiopulmonary bypass (36)(37)(38)(39)(40)(41), or use of an outdated robotic system other than the da Vinci system (18,34,35). Of the patients who were included for statistical analysis in the selected studies on off-pump TECAB, on-pump TECAB and robotic MIDCAB, the mean age ranged from 58 to 67, and 51-88% of patients were male.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review on robotic coronary artery bypass graft surgery

Cao

Indraratna

Doyle

et al. 2016

Ann. Cardiothorac. Surg.

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Background: Robotic-assisted coronary artery bypass graft surgery (CABG) has been performed over the past decade. Despite encouraging results from selected centres, there is a paucity of robust clinical data to establish its clinical safety and efficacy. The present systematic review aimed to identify all relevant clinical data on robotic CABG. The primary endpoint was perioperative mortality, and secondary endpoints included perioperative morbidities, anastomotic complications, and long-term survival.Methods: Electronic searches were performed using three online databases from their dates of inception to 2016. Relevant studies fulfilling the predefined search criteria were categorized according to surgical techniques as (I) totally endoscopic coronary artery bypass without cardiopulmonary bypass (TECAB offpump); (II) TECAB on-pump; and robotic-assisted mammary artery harvesting followed by minimally invasive direct coronary artery bypass (robotic MIDCAB).Results: The present systematic review identified 44 studies that fulfilled the study selection criteria, including nine studies in the TECAB off-pump group and 16 studies in the robotic MIDCAB group.Statistical analysis reported a pooled mortality of 1.7% for the TECAB off-pump group and 1.0% for the robotic MIDCAB group. Intraoperative details such as the number and location of grafts performed, operative times and conversion rates, as well as postoperative secondary endpoints such as morbidities, anastomotic complications and long-term outcomes were also summarized for both techniques.Conclusions: A number of technical, logistic and cost-related issues continue to hinder the popularization of the robotic CABG procedure. Current clinical evidence is limited by a lack of randomized controlled trials, heterogeneous definition of techniques and complications, as well as a lack of robust clinical followup with routine angiography. Nonetheless, the present systematic review reported acceptable perioperative mortality rates for selected patients at specialized centres. These results should be considered as a useful benchmark for future studies, until further data is reported in the form of randomized trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A systematic review on robotic coronary artery bypass graft surgery

Cao

Indraratna

Doyle

et al. 2016

Ann. Cardiothorac. Surg.

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“…For distal anastomosis, several methods were reported. Bonaros et al performed a running technique using 7-0 polypropylene suture, 18) and Balkhy et al used a coronary anastomotic connector (C-Port FREX A distal anastomotic device; Cardica, Redwood City, CA). 19) …”

Section: Surgical Technique For Ischemic Heart Diseasementioning

confidence: 99%

Robot-Assisted Cardiac Surgery

Ishikawa

Watanabe

2015

ATCS

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The significant advantages of minimizing surgical trauma, such as reduced pain, shorter hospital stays, faster return to normal activities, and improved cosmesis, have resulted in the development of minimally invasive surgery. 1) Until recently, various difficulties associated with endoscopic approaches had stalled similar progress in the field of cardiac surgery. However, robotic technology overcame the difficulties associated with conventional endoscopic surgery and has made possible a new approach to minimally invasive cardiac surgery.The application of robot-assisted coronary surgery ranges from internal mammary artery (IMA) harvesting with handsewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB) either on-or off-pump. The bilateral IMAs can be harvested with the aid of a surgical robot, and then multivessel bypass grafting can follow. Srivastava calls such robot-assisted minimally invasive direct coronary artery bypass grafting (MIDCAB) "ThoraCAB.'' 2) Surgical robots can not only endoscopically harvest the IMA, but they can also anastomose the coronary artery in TECAB.On the other hand, closed-chest cardiopulmonary bypass (CPB) and cardioplegic arrest have stimulated the development of minimally invasive cardiac surgery (MICS) via a small thoracotomy, 3) and this has now become universal, especially to treat valve diseases and congenital structural heart diseases. Endoscopic techniques are also required for MICS, but conventional endoscopic instrumentation lacks the dexterity required for delicate cardiac surgical procedures, and the loss of depth perception caused by twodimensional monitors further increases operative obstacles.Surgical robots have been developed to enhance surgical ability and precision, and to repair structural heart conditions, including mitral valve plasty (MVP), atrial septal defect closure, cardiac tumour resection, ThoraCAB, and TECAB. The most common applications in cardiac surgery are MVP and endoscopic coronary artery bypass grafting (CABG). da Vinci Surgical SystemThe da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) comprises a surgeon's console, a Robot-Assisted Cardiac SurgeryNorihiko Ishikawa, MD, PhD and Go Watanabe, MD, PhD Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardi...

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“…Several experienced groups have reported excellent outcomes using a robotic CABG approach (34)(35)(36). In their series of direct MVST CABG of which 75% were performed off-pump, Ruel and colleagues (37,38) report excellent graft patency (92% and 100% 6-month graft patency for all grafts and for LITA grafts, respectively).…”

Section: The Future Of Opcab: What Is the Role Of Minimally-invasive mentioning

confidence: 99%

The future of off-pump coronary artery bypass grafting: a North American perspective

2016

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Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets. Our rationale for OPCAB remains that if complete and precise revascularization can be safely and routinely accomplished, then the patient should benefit by avoiding the morbidities that can be attributed to aortic cannulation/clamping, cardiopulmonary bypass (CPB), hemodilution, hypothermia and global myocardial ischemia/cardioplegia.We further believe that OPCAB procedures should emphasize the use of arterial grafts to optimize long term patency and minimize aortic manipulation to limit the risk of stroke. Moving forward, the off-pump surgical community and specialty societies must address the challenge of training surgeons and their teams to master this technically demanding procedure. Furthermore, OPCAB opens the door to minimally-invasive surgical revascularization via hybrid coronary revascularization (HCR). A large NIH-funded RCT is currently underway to determine whether hybrid revascularization can offer a superior alternative to multi-vessel percutaneous coronary intervention for patients with low SYNTAX score and proximal LAD disease.

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Five Hundred Cases of Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Predictors of Success and Safety

Cited by 134 publications

References 38 publications

A systematic review on robotic coronary artery bypass graft surgery

A systematic review on robotic coronary artery bypass graft surgery

Robot-Assisted Cardiac Surgery

The future of off-pump coronary artery bypass grafting: a North American perspective

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