Document Detail


Totally endoscopic multivessel coronary artery bypass surgery using the da Vinci surgical system: a feasibility study on cadaveric models.
MedLine Citation:
PMID:  14722008     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of the study was to develop a totally endoscopic coronary artery bypass procedure for the treatment of multivessel disease (MVTECAB). METHODS: Procedure development was conducted on 6 human cadavers with the da Vinci Surgical System. For aortic clamping, a transthoracic aortic clamp was applied. The proximal anastomoses of vein grafts were created transthoracically with the Corlink automated anastomosis device. The target vessels on the heart were exposed with a modified endoscopically applicable Starfish vacuum device. In 1 cadaver, the endo-sling and endoscopic fan retractors were studied for exposure support. RESULTS: Harvesting of bilateral internal thoracic arteries was easily accomplished. Aortic clamping was easier from the right side. In the left-side approach, the proximal anastomoses were completed without leakage in all 3 cadavers. One incorrect deployment occurred, and the deployment needed to be redone. In the right-si d e approach, 1 proximal anastomosis was performed without leakage, and another needed to be repaired for incorrect deployment. The fan retractors either covered too much of the targeted area of the heart surface or did not provide good manipulation capabilities. The endo-sling enabled atraumatic exposure of the target vessels. The modified Starfish performed sufficiently for exposing target vessels. Problems were found with epicardial fat clogging the Starfish suction chamber and with bending of the suction tube neck, both of which resulted in a loss of tissue contact. Two of the cadavers approached from the left side were completely revascularized with 3 grafts, and 4 anastomoses were performed on the third cadaver. Triple-vessel revascularization was performed in the cadavers approached from the right side. CONCLUSION: This study demonstrates the feasibility of performing an MVTECAB on the arrested heart with the da Vinci Surgical System. Further procedure development is necessary to optimize the synergistic effects of the technologies used and to introduce this operation into clinical practice.
Authors:
Hubert Stein; Romuald Cichon; Gerhard Wimmer-Greinecker; Michael Ikeda; Douglas Hutchison; Volkmar Falk
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  6     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2003  
Date Detail:
Created Date:  2004-01-14     Completed Date:  2004-03-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E183-90     Citation Subset:  IM    
Affiliation:
Department of Clinical Development Engineering, Intuitive Surgical Inc, Sunnyvale, California, USA. hubert.stein@intusurg.com
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MeSH Terms
Descriptor/Qualifier:
Cadaver
Coronary Artery Bypass / methods*
Coronary Disease / pathology,  surgery*
Feasibility Studies
Humans
Image Processing, Computer-Assisted*
Robotics / methods*
Suture Techniques*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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