Robotically-Assisted Coronary Artery Bypass Surgery: Moving Toward A Completely Endoscopic Procedure

(#1999-6462 ... February 9, 1999)

Christopher T. Ducko, MD¹, Edward R. Stephenson, Jr, MD¹, Sachin Sankholkar, MS², Ralph J. Damiano, Jr, MD¹

¹ Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, Hershey, PA
² Computer Motion, Inc., Goleta, CA

ABSTRACT

Background: Endoscopic coronary artery bypass grafting (ECABG) has not been possible with traditional techniques. This report details our animal experience determining the feasibility of using a robotically-assisted microsurgical system to perform ECABG.

Methods: Following preliminary work using a cadaveric pig heart model, acute and chronic animal studies were performed. Calves were placed on cardiopulmonary bypass after the left internal mammary artery (LIMA) was harvested. Subxiphoid endoscopic ports (2 instrument, 1 camera) were placed and a robotic system was used to perform ECABG between the LIMA and left anterior descending coronary artery. LIMA graft flow (LIMAQ) was measured, and excised hearts underwent angiographic and histologic analyses.

Results: All anastomoses were successfully completed in both the acute and chronic studies (mean time of 33.9 ± 1.9 and 33.2 ± 3.4 minutes, respectively). Angiographic patency was 100% in both the acute (8/8) and chronic (6/6) studies, which was confirmed by histology. In the chronic study, there was no difference in LIMAQ between intraoperative and autopsy measurements.

Conclusions: This study shows that ECABG is feasible in an animal model with excellent results. The FDA has recently given approval for clinical trials of this new technology.

AUTHOR/ARTICLE INFORMATION

Reprint requests to: Ralph J. Damiano, Jr, MD, Chief, Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, 500 University Drive, Hershey, PA 17033; Phone: (717) 531-8330, Fax: (717) 531-3664, Email: rdamiano@psghs.edu

Submitted on: January 28, 1999

Keywords: minimally invasive surgery; cardiac surgery; coronary artery bypass grafting; robotically-assisted surgery; endoscopic; animal; anastomosis. ECABG = endoscopic coronary artery bypass grafting; LAD = left anterior descending coronary artery; LIMA = left internal mammary artery; RIMA = right internal mammary artery.