Does Preoperative Multislice Computed Tomography Predict Operative Times in Total Endoscopic Coronary Artery Bypass Grafting?

Anatomy-based eligibility measure for robotic-assisted bypass surgery

OBJECTIVE

Robotic-assisted endoscopic single-vessel small thoracotomy allows clinicians to perform coronary artery bypass grafting surgery in a minimally invasive manner using the da Vinci Surgical System. Not all patients are suitable for this technique, and the lack of an appropriate method for patient eligibility avoids completion of the procedure robotically. The objective of this study was to develop a patient eligibility method based on the anatomy of the chest of the patient.

METHODS

Preoperative computed tomography thorax scans of 110 patients were analyzed. Two-dimensional measurements taken on the axial images were used with the goal of finding a relation between the anatomy of the patient and the completion of the procedure robotically.

RESULTS

Patients with a distance from the left anterior descending coronary artery to the anterior chest wall of smaller than 15 mm have a 20% probability of requiring conversion of the procedure to open surgery. This probability increases if the chest of the patient is very elliptical, having an anterior-posterior dimension of less than 45% of the transverse dimension.

CONCLUSIONS

The smaller the distance is from the left anterior descending artery to the anterior chest wall, the lower the chances are of completing the procedure robotically.

Multislice Computed Tomography for Preoperative and Postoperative Assessment in Totally Endoscopic Coronary Artery Bypass Grafting

This article reviews the clinical value of noninvasive multi-slice computed tomography (MSCT) angiography before and after totally endoscopic coronary artery bypass surgery. The use of coronary and aorto-iliaco-femoral MSCT angiography in the preoperative assessment is addressed and the use of bypass MSCT angiography for postoperative control of bypass graft patency is discussed.

Robotic Endoscopic Left Internal Mammary Artery Harvesting: What Have We Learned After 100 Cases?

BACKGROUND

The development of robotic devices has recently offered the possibility of performing coronary artery bypass graft surgery (CABG) in a totally endoscopic way. An important step of this procedure is endoscopic harvesting of the left internal mammary artery (LIMA). It was the aim of our study to find factors influencing LIMA harvesting time and to describe the challenges associated with robotic endoscopic LIMA harvesting.

METHODS

From June 2001 to December 2005, a total of 100 patients underwent robotically assisted CABG. In all cases, the LIMA was harvested by using the robotic DaVinci device. Coronary artery bypass grafting procedures were completed through sternotomy, minithoracotomy, or in a totally endoscopic fashion.

RESULTS

The median LIMA harvesting time was 48 minutes (19 to 180). A significant learning curve was observed: y (min) = 151 - 26 x ln (x), x = LIMA takedown number, p less than 0.001. Takedown time decreased from 140 minutes in the first 10 cases to 34 minutes in the last 10 cases. There was no independent demographic factor that significantly influenced the LIMA harvesting time. The LIMA takedown time also showed no significant correlation with thorax dimensions. Injury to the LIMA occurred in 3 patients (6%) during the first half of the experience and in 1 patient (2%) during the second half (p = not significant).

CONCLUSIONS

Robotic-enhanced LIMA takedown is a prerequisite for totally endoscopic CABG. After passing through a significant learning curve, IMA takedown can be performed safely and within an acceptable time frame. Demography and chest size do not seem to influence IMA harvesting time. The rate of LIMA injuries is within the limits of conventional thoracoscopic harvesting.