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Improved Glottic Exposure for Robotic Microlaryngeal Surgery: A Case Series. J Voice 2017; 31:628-633. [PMID: 28318968 DOI: 10.1016/j.jvoice.2017.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
Robotic surgery has become the standard of care for many procedures outside of otolaryngology and now is gaining momentum within our specialty. The da Vinci (Intuitive Surgical, Sunnyvale, CA) robot has several advantages to human hands, including removal of tremor and better access to lesions because of increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotic surgery because access was previously thought to be difficult because of the limitations of currently used retractors, which include poor base of tongue and oral commissure retraction resulting in lack of exposure of the glottis in many patients and lack of space for the robotic instruments to occupy. We present a case series using the Modular Oral Retractor (MOR) system to show that the glottic larynx can be accessed by the da Vinci instrumentation. The MOR system provides better exposure of the anterior commissure and by using oral commissure retraction provides excellent space for the robotic arms to work. The MOR system potentially makes robotic microlaryngeal surgery more feasible for the otolaryngology-head and neck surgeon.
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Rodney JP, Vasan NR. Robotic microlaryngeal surgery: a new retractor that provides improved access to the glottis. SPRINGERPLUS 2016; 5:188. [PMID: 27026884 PMCID: PMC4769245 DOI: 10.1186/s40064-016-1788-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/12/2016] [Indexed: 11/11/2022]
Abstract
Robotic surgery has become the standard of care for many procedures outside of otolaryngology, and now is gaining momentum within our specialty. The robot has several advantages to human hands, including removal of tremor and better access to lesions due to increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotics because access was previously thought to be difficult. We present a case report using the modular oral retractor system to perform robotic microlaryngeal surgery.
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Affiliation(s)
- Jennifer P Rodney
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma, OK 73126-0901 USA
| | - Nilesh R Vasan
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma, OK 73126-0901 USA
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Sert MB, Eraker R. Robot-assisted laparoscopic surgery in gynaecological oncology; initial experience at Oslo Radium Hospital and 16 months follow-up. Int J Med Robot 2009; 5:410-4. [DOI: 10.1002/rcs.272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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4
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Hybrid Coronary Revascularization by Endoscopic Robotic Coronary Artery Bypass Grafting on Beating Heart and Stent Placement. Ann Thorac Surg 2009; 87:737-41. [PMID: 19231382 DOI: 10.1016/j.athoracsur.2008.12.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 11/27/2008] [Accepted: 12/01/2008] [Indexed: 01/27/2023]
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Mishra YK, Wasir H, Sharma KK, Mehta Y, Trehan N. Totally endoscopic coronary artery bypass surgery. Asian Cardiovasc Thorac Ann 2008; 14:447-51. [PMID: 17130316 DOI: 10.1177/021849230601400601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Robotically enhanced surgery is a fast-developing technique that allows totally endoscopic cardiac surgery on both the beating and arrested heart. Between December 2002 and May 2005, 13 patients underwent totally endoscopic coronary bypass using the da Vinci system; 11 operations were on a beating heart and 2 on arrested hearts. The mean time for internal mammary artery mobilization was 42 min. The time for left internal mammary artery-to-left anterior descending artery anastomosis was 20-36 min for totally endoscopic cases. In one patient, the right internal mammary artery was anastomosed to the diagonal artery. No patient required conversion to a median sternotomy. Mean intensive care unit stay was 1.2 days and mean hospital stay was 4.5 days. There was no hospital mortality. All 13 patients had coronary angiography at 3-month intervals, which showed 100% patency in 12 patients while one had 50% anastomotic narrowing for which coronary angioplasty was performed. Using robotic technology, completely endoscopic anastomosis is possible in patients with single-vessel disease. Use of robotics is now extended to achieve complete myocardial revascularization by harvesting both internal mammary arteries in addition to making a small thoracotomy for direct anastomosis.
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Affiliation(s)
- Yugal K Mishra
- Department of Cardiovascular Surgery, Escorts Heart Institute and Research Center, New Delhi, India.
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Ak K, Wimmer-Greinecker G, Dzemali O, Moritz A, Dogan S. Totally endoscopic sequential arterial coronary artery bypass grafting on the beating heart. Can J Cardiol 2007; 23:391-2. [PMID: 17440646 PMCID: PMC2649191 DOI: 10.1016/s0828-282x(07)70774-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 50-year-old man was referred to the Department of Thoracic and Cardiovascular Surgery at the Johann Wolfgang-Goethe University (Frankfurt, Germany) with angina on exertion. An evaluation revealed critical stenosis involving the proximal portion of the left anterior descending artery and the first diagonal branch. The patient underwent successful sequential grafting of the left internal mammary artery to the left anterior descending artery and the diagonal branch using a totally endoscopic coronary artery bypass grafting technique on the beating heart with a new version of the da Vinci Surgical System (Intuitive Surgical, USA). To the authors' knowledge, this is the first report in literature to describe sequential arterial off-pump grafting of two anterior wall target vessels using a totally endoscopic technique on the beating heart.
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Affiliation(s)
- Koray Ak
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University, Frankfurt, Germany.
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Mishra YK, Wasir H, Rajneesh M, Sharma KK, Mehta Y, Trehan N. Robotically enhanced coronary artery bypass surgery. J Robot Surg 2007; 1:221-6. [PMID: 25484967 PMCID: PMC4247435 DOI: 10.1007/s11701-007-0029-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/04/2007] [Indexed: 12/03/2022]
Abstract
Robotically enhanced telemanipulation surgery is a rapidly developing technique which enables totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart and arrested heart. Between December 2002 and September 2006, 268 patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system. Fourteen patients underwent total endoscopic coronary artery bypass surgery. Of these 12 were performed on a beating heart and 2 on an arrested heart. Two-hundred and fifty-four patients had endoscopic takedown of the internal mammary artery followed by minimally invasive direct coronary artery bypass in 193 patients and left anterolateral thoracotomy in 61 patients. The internal mammary artery mobilization time was 36 min (28–76 min) and the left internal mammary artery to left anterior descending artery anastomosis time ranged from 20 to 36 min for the totally endoscopic coronary artery bypass patients. The right internal mammary artery of one patient was anastomosed to diagonal artery totally endoscopically. The mean internal mammary artery flow by Doppler measurement in patients undergoing minimally invasive direct coronary artery bypass was 58 ml min−1. Seven patients required conversion to median sternotomy and coronary bypass surgery on the beating heart. The mean intensive care unit stay was 1.2 days and the mean hospital stay 4.5 days. There was one in-hospital mortality. All 14 patients who underwent total endoscopic bypass surgery had coronary angiography 3 months later which showed 100% patency in 13 patients. One patient had 50% anastomotic narrowing for which coronary angioplasty was performed in the same sitting. By using telematic technology, a complete endoscopic anastomosis is possible in both single vessels and suitable double vessel disease patients. The use of robotics is now extended to achieve complete myocardial revascularization by harvesting both the internal mammary arteries and making a small thoracotomy for direct anastomosis also.
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Affiliation(s)
- Yugal K Mishra
- Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, 110025 India
| | - H Wasir
- Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, 110025 India
| | - Malhotra Rajneesh
- Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, 110025 India
| | - K K Sharma
- Department of Cardiovascular Anesthesiology, Escorts Heart Institute and Research Centre, New Delhi, India
| | - Y Mehta
- Department of Cardiovascular Anesthesiology, Escorts Heart Institute and Research Centre, New Delhi, India
| | - N Trehan
- Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, 110025 India
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Wimmer-Greinecker G, Dzemali O, Aybek T, Keller H, Mierdl S, Moritz A, Dogan S. Perfusion strategies for totally endoscopic cardiac surgery. Multimed Man Cardiothorac Surg 2006; 2006:mmcts.2005.001206. [PMID: 24413327 DOI: 10.1510/mmcts.2005.001206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For most of totally endoscopic cardiac procedures femoro-femoral perfusion techniques are necessary. Use of selective bicaval as well as single venous drainage is described. Furthermore, the use of different intraaortic balloons for aortic occlusion is explained and illustrated. Advantages and disadvantages of different systems, potential pitfalls and their solutions are discussed.
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Affiliation(s)
- Gerhard Wimmer-Greinecker
- Department for Thoracic and Cardiovascular Surgery, JW Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany
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Sagbas E, Akpinar B, Sanisoglu I, Caynak B, Guden M, Ozbek U, Bayramoglu Z, Bayindir O. Robotics in cardiac surgery: the Istanbul experience. Int J Med Robot 2006; 2:179-87. [PMID: 17520629 DOI: 10.1002/rcs.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Robots are sensor-based tools capable of performing precise, accurate and versatile actions. Initially designed to spare humans from risky tasks, robots have progressed into revolutionary tools for surgeons. Tele-operated robots, such as the da Vinci (Intuitive Surgical, Mountain View, CA), have allowed cardiac procedures to start benefiting from robotics as an enhancement to traditional minimally invasive surgery. METHODS The aim of this text was to discuss our experience with the da Vinci system during a 12 month period in which 61 cardiac patients were operated on. There were 59 coronary bypass patients (CABG) and two atrial septal defect (ASD) closures. RESULTS Two patients (3.3%) had to be converted to median sternotomy because of pleural adhesions. There were no procedure- or device-related complications. CONCLUSION Our experience suggests that robotics can be integrated into routine cardiac surgical practice. Systematic training, team dedication and proper patient selection are important factors that determine the success of a robotic surgery programme.
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Affiliation(s)
- Ertan Sagbas
- Departments of Cardiovascular Surgery and Anaesthesia, Florence Nightingale Hospital, Istanbul, Turkey
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Hockstein NG, Nolan JP, O'Malley BW, Woo YJ. Robot-assisted pharyngeal and laryngeal microsurgery: results of robotic cadaver dissections. Laryngoscope 2005; 115:1003-8. [PMID: 15933510 DOI: 10.1212/01.wnl.0000164714.90354.7d] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Robotic surgery has significant potential in pharyngeal and microlaryngeal surgery. We demonstrate the use of a surgical robot in pharyngeal and microlaryngeal surgery in a cadaver. STUDY DESIGN Six experimental surgical dissections, modeled after commonly performed pharyngeal and microlaryngeal procedures, were performed in a cadaver with a commercially available surgical robot in an operating room suite to demonstrate proof of concept. METHODS Using the daVinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA), surgical procedures were performed on an edentulous, female cadaver. The procedures included 1) bilateral true vocal cord stripping, 2) rotation of a mucosal flap from the epiglottis to the anterior commissure, 3) partial vocal cordectomy, 4) arytenoidectomy, 5) partial epiglottectomy and thyrohyoid dissection and 6) partial resection of the base of tongue with primary closure. All procedures were timed and documented with still and video photography. RESULTS The daVinci Surgical Robot, with currently available instruments, enabled performance of several laryngeal and pharyngeal surgical procedures on a cadaver. Laryngeal and pharyngeal exposure was excellent, instruments movement was unimpeded, tissue handling was delicate and precise, and endolaryngeal suturing was relatively easily performed. The duration of the different robotic cadaver dissections was comparable to procedure duration using conventional techniques. CONCLUSIONS Using the daVinci Surgical Robot, six different pharyngeal and microlaryngeal dissections were successfully performed in a cadaver. The recent development of surgical robotics has a potential role in pharyngeal and microlaryngeal surgery. Surgical robots offer the ability to manipulate instruments at their distal ends with increased freedom of movement, scaled movement, tremor buffering, and under stereoscopic three-dimensional visualization. Surgical robots may increase the precision with which we perform currently described procedures; additionally, surgical robots may advance the field of endoscopic laryngeal and pharyngeal surgery.
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Affiliation(s)
- Neil G Hockstein
- Department of Otorhinolaryngology--Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Hockstein NG, Nolan JP, O'malley BW, Woo YJ. Robotic Microlaryngeal Surgery: A Technical Feasibility Study Using the daVinci Surgical Robot and an Airway Mannequin. Laryngoscope 2005; 115:780-5. [PMID: 15867639 DOI: 10.1097/01.mlg.0000159202.04941.67] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The trend toward minimally invasive surgery has led to the development and mastery of endoscopic and laparoscopic surgical techniques. These minimally invasive approaches, which only two decades ago were either novel or experimental, are now mainstream. More recently, robot-assisted surgery has evolved as an adjunct to open and endoscopic techniques. Surgical robots are now approved by the United States Food and Drug Administration for a variety of thoracic and abdominal/pelvic surgical procedures. The purpose of this study is to demonstrate the technical feasibility of robot-assisted microlaryngeal surgery. STUDY DESIGN Experimental surgical manipulation of the larynx in an airway mannequin with a surgical robot. METHODS A variety of laryngoscopes and mouthgags, coupled with the daVinci Surgical Robot's (Intuitive Surgical, Sunnyvale, CA) 0-degree and 30-degree, two-dimensional and three-dimensional endoscopes, were utilized to optimize visualization of the larynx in an airway mannequin. Five millimeter and 8 mm microinstruments compatible with the daVinci robot were utilized to manipulate different elements of the larynx. Experiments were recorded with both still and video photography. RESULTS The endoscope and robotic arms of the daVinci robot are well suited to airway surgery. CONCLUSIONS Robot-assisted laryngeal surgery can be performed with currently available technology. The potential for fine manipulation of tissues, increased freedom of instrument movement, and endolaryngeal suturing may increase the precision of endoscopic laryngeal microsurgery and offers the potential to increase the variety of laryngeal procedures that can be performed endoscopically.
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Affiliation(s)
- Neil G Hockstein
- Department of Otorhinolaryngology--Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Totally endoscopic coronary artery bypass graft. Surg Endosc 2004. [DOI: 10.1007/bf02637125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dogan S, Aybek T, Risteski P, Mierdl S, Stein H, Herzog C, Khan MF, Dzemali O, Moritz A, Wimmer-Greinecker G. Totally endoscopic coronary artery bypass graft: initial experience with an additional instrument arm and an advanced camera system. Surg Endosc 2004; 18:1587-91. [PMID: 15931491 DOI: 10.1007/s00464-003-9193-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Accepted: 04/07/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback, traction, or countertraction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature. METHODS The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative field beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon. RESULTS The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195 +/- 58, 25 +/- 10, and 18 +/- 5 min, respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique. CONCLUSIONS The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community.
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Affiliation(s)
- S Dogan
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Wimmer-Greinecker G, Deschka H, Aybek T, Mierdl S, Moritz A, Dogan S. Current status of robotically assisted coronary revascularization. Am J Surg 2004; 188:76S-82S. [PMID: 15476656 DOI: 10.1016/j.amjsurg.2004.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article reviews the current status of totally endoscopic coronary revascularization using telemanipulation systems for robotic assistance. Current challenges in implementing a robotic surgical program are discussed, and application of the technology in both arrested and beating heart procedures is considered.
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Affiliation(s)
- Gerhard Wimmer-Greinecker
- Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern Kai 7. D-60590 Frankfurt, Germany.
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Klima U, Falk V, Maringka M, Bargenda S, Badack S, Moritz A, Mohr F, Haverich A, Wimmer-Greinecker G. Magnetic vascular coupling for distal anastomosis in coronary artery bypass grafting: a multicenter trial. J Thorac Cardiovasc Surg 2004; 126:1568-74. [PMID: 14666034 DOI: 10.1016/s0022-5223(03)01314-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The hand-sewn anastomosis is the "gold standard" for performing coronary artery bypass grafts. However, performing a hand-sewn anastomosis is more demanding and time-consuming when used in less invasive approaches such as small access, totally endoscopic or beating heart surgery. In conjunction with attempts to reduce the surgical trauma of coronary artery bypass grafts by using these less invasive approaches, alternative methods for constructing distal anastomoses should be explored. These data report on predischarge angiographic findings and 30-day clinical follow up of patients who have received a new distal anastomotic device. METHODS In a multicenter trial, 32 patients (mean age: 65 +/- 9 years; 85% men) requiring multivessel coronary artery bypass surgery had 1 of the anastomoses performed using a novel anastomotic technology. The Magnetic Vascular Positioner System was used in 1 of the bypass grafts and the other bypasses were completed by conventional hand-sewn technique. The Magnetic Vascular Positioner System consists of 4 magnetic, gold-plated implants and 2 delivery devices that facilitate the creation of a functional end-to-side anastomosis. A predischarge angiogram was performed to evaluate graft patency. RESULTS There were no device-related major adverse events. The application of the Magnetic Vascular Positioner device was successful in 32 of 41 cases (78%). Nine patients were intended for treatment but did not receive the Magnetic Vascular Positioner System. In 5 of the cases the coronary artery was too small; 1 case had a posterior wall plaque in the target artery; and 3 patients had a nonhemostatic anastomosis after coupling of the port and were subsequently converted to hand-sewn anastomoses. The median total Magnetic Vascular Positioner anastomotic time was 137 seconds with a range from 65 to 370 seconds. Overall patency rate of the Magnetic Vascular Positioner anastomosis was 93.5% versus 91.7% (P = not significant) in hand-sewn grafts. One patient (3.1%) died due to low cardiac output but had patent grafts at autopsy. One myocardial infarction (3.1%) occurred the day after a percutaneous transluminal coronary angioplasty of a hand-sewn graft. One prolonged mechanical ventilation (3.1%) was required because of pneumonia and adult respiratory distress syndrome. CONCLUSIONS Magnetic vascular coupling in coronary surgery is safe and effective and has acceptable early patency rates. This new technique may facilitate beating heart and minimally invasive coronary artery bypass grafts.
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Affiliation(s)
- Uwe Klima
- Division of Thoracic and Cardiovascular Surgery, Medical School, Hannover, Germany.
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Herzog C, Dogan S, Diebold T, Khan MF, Ackermann H, Schaller S, Flohr TG, Wimmer-Greinecker G, Moritz A, Vogl TJ. Multi–Detector Row CT versus Coronary Angiography: Preoperative Evaluation before Totally Endoscopic Coronary Artery Bypass Grafting. Radiology 2003; 229:200-8. [PMID: 14519876 DOI: 10.1148/radiol.2291020630] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings. MATERIALS AND METHODS Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery. RESULTS Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified. CONCLUSION Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.
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Affiliation(s)
- Christopher Herzog
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Falk V, Jacobs S, Gummert JF, Walther T, Mohr FW. Computer-enhanced endoscopic coronary artery bypass grafting: the da Vinci experience. Semin Thorac Cardiovasc Surg 2003. [DOI: 10.1016/s1043-0679(03)70018-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dogan S, Graubitz K, Aybek T, Khan MF, Kessler P, Moritz A, Wimmer-Greinecker G. How safe is the port access technique in minimally invasive coronary artery bypass grafting? Ann Thorac Surg 2002; 74:1537-43; discussion 1543. [PMID: 12440605 DOI: 10.1016/s0003-4975(02)03947-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study compares conventional coronary artery bypass grafting (CABG) with port access CABG via a left anterior small thoracotomy in patients requiring surgical multivessel revascularization. Clinical, neuropsychological, and angiographic outcomes were studied, as well as parameters of myocardial and cerebral protection. Pathogenicity of cardiopulmonary bypass (CPB) was further evaluated by measuring parameters of peripheral limb ischemia and inflammatory whole-body response. METHODS In a prospective randomized study, 40 patients who required multivessel CABG were assigned to either conventional CABG via complete median sternotomy (group A) or port access CABG via minithoracotomy (group B). Control angiograms were performed in group B only. In addition, patients underwent neuropsychological testing after the operation. CK, CK-MB, and Troponin T levels were documented. S-100B protein and neuron-specific enolase (NSE) served to quantify cerebral injury. The terminal complement complex (C5b-9) and myeloperoxidase concentrations were determined to analyze inflammatory whole-body response after CPB. RESULTS There was no mortality. One patient suffered a retrograde aortic dissection immediately after onset of CPB, but had an uneventful postoperative course after surgical repair. Troponin T and CK-MB showed no difference between groups. CK and myoglobin were significantly higher in the minimally invasive cohort. Changes in complement activation (C5b-9) and myeloperoxidase during CPB markers of the whole-body inflammatory response were similar in both groups. S-100B concentrations in the port access group were significantly higher, whereas NSE levels were similar in both groups. Both groups did not display any significant difference in neuropsychological testing. CONCLUSIONS Minimally invasive multivessel CABG via minithoracotomy using port access technology is feasible and safe. Though prolonged operating and CPB times with significantly higher S-100B concentrations were observed in group B, equivalent myocardial and cerebral protection and similar whole-body inflammatory response were documented.
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Affiliation(s)
- Selami Dogan
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Frankfurt, Germany.
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Dogan S, Aybek T, Andressen E, Byhahn C, Mierdl S, Westphal K, Matheis G, Moritz A, Wimmer-Greinecker G. Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovasc Surg 2002; 123:1125-31. [PMID: 12063459 DOI: 10.1067/mtc.2002.121305] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Robotically enhanced telemanipulation is a new powerful tool for minimally invasive procedures that allows totally endoscopic cardiac surgery. Between June 1999 and February 2001, 45 robotically enhanced totally endoscopic coronary artery bypass grafting procedures on the arrested heart were performed at our institution with the use of the da Vinci telemanipulation system (Intuitive Surgical, Inc, Mountain View, Calif). METHODS In 37 patients a single-vessel totally endoscopic coronary bypass operation was performed. Eight patients had different types of multivessel revascularization with both internal thoracic arteries. The initial conversion rate was 22% and dropped to 5% in the last 20 patients. Two patients required reexploration via median sternotomy. The first 22 patients had excellent graft patency on discharge. The procedural time for single-vessel totally endoscopic bypass was 4.2 +/- 0.4 hours, bypass time was 136 +/- 11 minutes, and aortic crossclamp time amounted to 61 +/- 5 minutes. CONCLUSION The present data show the feasibility of closed chest single- and double-vessel revascularization, with good clinical results. However, procedural time is prolonged and the complex endoscopic and endoaortic occlusion techniques, as well as the extensive anesthesiologic monitoring, are demanding. The need for conversion to an open procedure diminished after a relatively short learning curve. All postulated benefits of totally endoscopic surgery other than excellent cosmesis must be evaluated in larger cohorts.
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Affiliation(s)
- S Dogan
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
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Perrault LP, Hébert Y, Carrier M. Implementation of new technology for CABG in low-risk patients: could it be too soon? Ann Thorac Surg 2002; 73:1020. [PMID: 11899161 DOI: 10.1016/s0003-4975(01)03550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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