Minimal access coronary revascularisation without cardiopulmonary bypass—the impact of robotic technology in the current clinical practice

Abstract

Recent advances in interventional cardiology and cardiac surgery have changed the traditional therapeutic algorithms by altering indications, timing and patterns of referral for subsequent surgical treatment. The traditional longitudinal sternomy incision has been the surgical approach of choice for multi-vessel coronary revascularisation. Drawbacks of this incision include potential postoperative morbidity, which translates to a prolonged postoperative length of stay. The combination of minimally invasive direct coronary artery bypass (MIDCAB) with percutaneous transluminal coronary angioplasty (PTCA) or stenting (a hybrid approach) is an alternative therapeutic method for patients with multivessel coronary artery disease. Recent advances in percutaneous interventions have attempted to address the problem of re-stenosis, initially through the deployment of bare metal intra-coronary stents and, more recently, with drug-eluting stents. Developments in coronary revascularisation have focused on reducing both surgical invasiveness and trauma. Patients with significant co-morbid pathologies, the ones undergoing re-interventions, and especially the elderly may benefit from such hybrid procedures by avoiding cardiopulmonary bypass and midline sternotomy. Minimally invasive techniques have revolutionized cardiothoracic surgery by increasing patient satisfaction and by reducing surgical trauma, hospital stay and consequently overall costs. There are however limitations. Robot assisted surgery endeavours to minimise these technical hindrances and so allow better and more accurate surgical practice whilst minimising surgical trauma.

Robotically assisted atraumatic coronary artery bypass: a feasible option for off-pump coronary surgery

“…The hybrid approach was also considered in patients with multi-vessel disease with signiWcant co-morbidities [7] such as diabetes in 22% of hybrids, moderate to severe left ventricular dysfunction in 21% of hybrids and those who had undergone repeated percutaneous or open coronary interventions each in 1% of hybrids. Robotic surgery was considered in the elderly to reduce surgical trauma [4].…”

Role of the Robot in Totally Laparoscopic Aortic Repair for Occlusive and Aneurysmal Disease

“…It also uses all the advantages of minimally invasive methods. It is specifically used for general abdominal surgery, gynaecology, urology, oncosurgery, thoracic surgery, vascular surgery and cardiac surgery (9)(10)(11)(12).…”

Computer‐assisted navigation applied to fetal cardiac intervention

“…Computer-assisted (augmented) visualization has increased both the speed and accuracy of targeting small structures during remote (robotic) surgery (16)(17)(18)(19)(20)(21)(22)(23) and minimally invasive interventional procedures (24)(25)(26). Instrument localization and navigation within the body has been aided by three-dimensional (3D) guided registration techniques and by the development of implantable electromagnetic sensors and graphical registration software (27)(28)(29)(30)(31)(32)(33).…”