Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery

Wehman, Brody; Lehr, Eric J.; Lahiji, Kian; Lee, Jeffry D.; Kon, Zachary N.; Jeudy, Jean; Griffith, Bartley P.; Bonatti, Johannes

doi:10.1093/icvts/ivu226

Cited by 12 publications

(6 citation statements)

References 23 publications

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“…Similar to their results, the mean robotic operative time in our study was similar regardless of BMI (morbid obesity vs others; TECAB = 271 min vs 289 min, MVS = 312 min vs 331 min). Wehman et al 22 analyzed the computed tomography findings of patients undergoing TECAB and concluded that some of the anatomical findings (distance from the heart to the chest wall, pericardial fat, subcutaneous tissue) negatively affect the operative time, but not BMI.…”

Section: Discussionmentioning

confidence: 99%

Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery

Kuwabara

Patel

McCrorey

et al. 2017

Innovations�(Phila)

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Objective Morbid obesity (body mass index S 35 kg/m2)usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. Methods We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. Results A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years). The robotic procedures were the following: totally endoscopic beating heart coronary artery bypass (n = 263), mitral valve surgery (n = 138), arrhythmia surgery (n = 33), adult congenital surgery (n = 16), pericardiectomy (n = 11), and others (n = 25). The cohorts were divided into the following: normal weight (body mass index < 25, n = 123), overweight (body mass index = 25 to < 30, n = 182), obesity (body mass index = 30 to < 35, n = 105), and morbid obesity (body mass index S 35, n = 76). Morbidly obese patients had a higher rate of hypertension, dyslipidemia, and diabetes mellitus compared with normal or overweight patients. There were no significant differences in morbidity, mean length of intensive care unit stay (2.10 ± 4.27 days), and hospital stay (4.48 ± 5.61 days) among the groups. In-hospital mortality was 1.4% (7/486) with nonsignificant difference. Conclusions Outcomes of robotic heart surgery in morbidly obese patients in our center were acceptable. Over a broad range of cardiac surgical procedures, morbid obesity was not associated with increased morbidity or mortality when these procedures were performed using a robotic approach. These findings can be beneficial in managing this challenging group of patients.

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Section: Discussionmentioning

confidence: 99%

Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery

Kuwabara

Patel

McCrorey

et al. 2017

Innovations�(Phila)

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“…We use a 35 mm ascending aortic diameter as the upper limit for size. Other anatomical features such as the thickness of the pericardial fat pad and subcutaneous tissue at the nipple line have been shown to impact the duration of robotic left internal mammary artery (LIMA) harvesting, whereas LIMA-left anterior descending artery (LAD) anastomotic and overall operative times have been shown to be longer when the heart is closer to the chest wall in beating heart TECAB but not in arrested TECAB (8). These specifics, along with the availability of the endostabilizer, may guide the surgeon's decision making on whether to arrest or perform beating heart TECAB.…”

Section: Patient Selectionmentioning

confidence: 99%

Robotic totally endoscopic coronary artery bypass grafting—port placements, internal mammary artery harvesting and anastomosis techniques

Seese¹,

Ashraf²,

Davila³

et al. 2023

J Vis Surg

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Coronary artery surgery has evolved substantially over the past several decades. Many of these enhancements have offered patients improvements in graft patency and have decreased the morbidity of coronary surgery. Robotic totally endoscopic coronary artery bypass (TECAB) grafting is a procedure in which all main operative steps including anastomotic suturing are carried out by surgeons using a surgical robot through endoscopic port site incisions. The procedure can be performed as a standalone operation with multiple arterial grafts or as part of hybrid coronary interventions with cardiology colleagues. In the hybrid approach, patients will undergo TECAB and then have percutaneous coronary intervention with placement of drug eluting stents performed during the same hospitalization. Robotic TECAB is a versatile procedure that provides patients the benefits of quicker recovery with enhanced quality of life and no sternal precautions. Although there is a learning curve, TECAB is an important procedure to master that cardiac surgeons who are looking towards the future of our specialty should have available in their armamentarium to address coronary disease. In this technical article, we present the detailed preparation and technical conduct of the TECAB grafting in its arrested heart version using peripheral cardiopulmonary bypass and cardioplegia through an endoaortic balloon catheter. We also explore patient selection, clinical advantages, procedural challenges, and expert operator guidance for avoiding complications.

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“…There were interesting publications on the application of medical image measurement techniques for establishing the anatomical features that may affect the duration [18] or chance of success of robotic surgical procedures [19]. …”

Section: Analysis Of Scientific Reportsmentioning

confidence: 99%

Medical robots in cardiac surgery – application and perspectives

Kroczek

Nawrat

2017

kitp

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Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than one hundred thousand minimally invasive robotic surgical procedures every year. A surgical robot can be used by surgical teams on a rotational basis. The market of surgical robots used for cardiovascular and lung surgery was worth 72.2 million dollars in 2014 and is anticipated to reach 2.2 billion dollars by 2021. The analysis shows that Poland should have more than 30 surgical robots. Moreover, Polish medical teams are ready for the introduction of several robots into the field of cardiac surgery. We hope that this market will accommodate the Polish Robin Heart robots as well.

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Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery

Cited by 12 publications

References 23 publications

Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery

Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery

Robotic totally endoscopic coronary artery bypass grafting—port placements, internal mammary artery harvesting and anastomosis techniques

Medical robots in cardiac surgery – application and perspectives

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