Endoscopic Coronary Artery Bypass Graft (ECABG) Procedure with Robotic Assistance

(#1999-0552 ... September 7, 1999)

Harold A. Tabaie, DO, PhD, Jeffrey A. Reinbolt, BS, W. Peter Graper, MD, Thomas F. Kelly, MD, Michael A. Connor, RN

The Center for Advanced Surgery, Sarasota Memorial Healthcare System, Sarasota, Florida.

ABSTRACT

Background: Technical details of the Robotically assisted endoscopic coronary artery bypass graft (ECABG) procedure on the cadaver model are reported. Moreover, this study will provide essential techniques, steps, and procedural development concepts necessary to introduce the ZEUS™ Robotic Surgical System (Computer Motion, Inc., Goleta, CA) into the human operating room.

Methods: Between August 1998 and March 1999, an ECABG procedure was performed on 10 cadaver torsos. The cadaver torso was placed in the left anterior oblique (LAO) position. The left and right internal mammary arteries (IMA) were taken down endoscopically. The ends of the IMA's were intracorporeally prepared. An upper partial sternotomy was demonstrated for perfusion cannulation and proximal anastomoses for multiple vessel revascularization. An arteriotomy was created with an endoscopic scalpel. The IMA was anastomosed to a chosen coronary using robotic assistance. The patency was verified by probing and injecting of methylene blue.

Results: Templates were developed to determine the placement of the robotic arms. Port templates were developed to both harvest the IMA's and perform the desired anastomoses. The following vessels were accessed through the developed port templates and retraction of the heart: left anterior descending (LAD), right coronary artery (RCA), diagonal (D₁), obtuse marginal (OM₁ and OM₂), and posterior descending artery (PDA).

Conclusions: The use of robotic assistance during an ECABG procedure on a cadaver model is feasible. This study is a necessary and useful progression from the use of robotics in the animal lab to the use of robotics in the human operating room.

AUTHOR/ARTICLE INFORMATION

Reprint requests to: Harold A. Tabaie, D.O., Ph.D., Bradenton Cardiac Surgeons, Riverside Medical Center, Suite 2600, 300 Riverside Drive East, Bradenton, FL 34208; Ph. (941)746-0221; Fax. (941)750-0473

Submitted on: September 3, 1999; Accepted on: September 7, 1999