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

Abstract

This retrospective study of the largest single center experience (100 patients) with off-pump robotically assisted coronary procedures in the United Kingdom (April 2002-June 2008) aimed to rationalize patient selection, describe the technique, and determine the learning curve, technical feasibility and operative outcome of robotically assisted Atraumatic Coronary Artery Bypass (ACAB). Selected patients underwent either a robotic Totally Endoscopic Coronary Artery Bypass (12) or robotically assisted ACAB (88) using a standard Da Vinci robot with three arms. A fifth of all cases had percutaneous interventions as part of a hybrid strategy. The majority of patients were overweight men. After one hundred robotic coronary procedures, this operation is now performed as part of a routine theatre list. The mean operative and total procedure times for robotically assisted atraumatic procedures were 157 and 238 min, respectively. These measurements were significantly less in the atraumatic than the totally endoscopic group with a 34.3 and 20.6% reduction, respectively (P < 0.001; equal variance not assumed). The procedural learning curve was short and independent from internal thoracic artery harvesting. We have proven conclusively that robotically assisted ACAB is feasible, more so than the totally endoscopic procedure in this particular setting. Even in the absence of an ideal stabilizer device, this procedure causes minimal disruption to the daily operating room schedule. We have also proven that body mass index is a weak predictor of the ease of robotic internal thoracic artery harvesting and should not affect patient selection.

The midterm outcome and MACE of robotically enhanced grafting of left anterior descending artery with left internal mammary artery

“…Being overweight did not necessarily make this operation more difficult [4]. However as the robotic arms are relatively cumbersome the shape of the patient becomes a limiting factor.…”

“…We reported our anecdotal evidence in favour of robotic enhancement through earlier return to activities of daily living in our last publication [4]. However there have been no randomised trials in this subject.…”

“…Obesity is not an independent risk factor for poor outcome in minimally invasive cardiac surgery [ 16 ]. Being overweight did not necessarily make this operation more difficult [ 4 ]. However as the robotic arms are relatively cumbersome the shape of the patient becomes a limiting factor.…”

“…Finally although there is evidence supporting the use of the robot to improve post operative pain, general health and physical function scores as compared to conventional sternotomy [ 11 ], these conclusions have been drawn from observational studies. We reported our anecdotal evidence in favour of robotic enhancement through earlier return to activities of daily living in our last publication [ 4 ]. However there have been no randomised trials in this subject.…”

“…Since our first reports of successful attempts at robotically assisted coronary revascularisation back at imperial college [2,3], over one hundred coronary procedures have been successfully performed using the same second generation Da Vinci robot (Figure 1). In 2010 we published the results of a feasibility study and our short term outcomes in the same group of patients [4]. In the current study in accordance to the definition, and the principles of best practice in clinical audit [5,6], we compared our midterm outcomes of mortality and major adverse cardiovascular events (MACE) against international literature.…”