Robotic-Enhanced Dresden Technique for Minimally Invasive Bilateral Internal Mammary Artery Grafting

(#2000-9909 ... June 8, 2000)

Utz Kappert, MD,¹ Romuald Cichon, MD,¹ Vassilios Gulielmos, MD,¹ Jens Schneider, MD,¹ Ina Schramm, MD,¹ Joachim Nicolai, MD,² Sems-Malte Tugtekin, MD,¹ Stephan Schueler, MD, PhD¹

¹Department of Cardiac Surgery,
²Department of Anesthesiology;
Cardiovascular Institute, University of Dresden, Germany

ABSTRACT

Background: The introduction of robotic-enhanced endoscopic instrumentation systems allows the surgeon to perform arterial revascularization for multivessel coronary ar-tery disease without sternotomy.

Methods: From April 1999, 27 patients (6 female, 21 male, median age 63 ± 8.2 years) suffering from multivessel coronary artery disease were treated surgically using arterial revascularization by means of bilateral internal mammary artery (BIMA) grafting. Both arteries were harvested totally endoscopically using the da Vinci™ robotic surgical system (Intuitive Surgical, Mountain View, CA). These vessels were anastomosed using the "Dresden Technique" via a left minithoracotomy in the second intercostal space.

Results: All patients survived the operation. The mean duration of surgery was 240 ± 79.4 minutes. Bilateral internal mammary artery harvesting time was 88.5 ± 15.9 minutes, and cross-clamp time was 38 ± 10.9 minutes. An average of 2.07 anastomoses were performed per operation. Postoperatively, the patients remained in ICU for 20 ± 2.4 hours. One patient needed reexploration due to bleeding.

Conclusions: Bilateral internal mammary artery harvesting can be achieved safely with the use of wrist-enhanced instrumentation. The robotic surgical system introduces into surgical practice a new type of treatment of coronary artery disease, helping to perform arterial revascularization with a distinctly reduced surgical trauma.

AUTHOR/ARTICLE INFORMATION

Presented at the Third Annual Meeting of the International Society for Minimally Invasive Cardiac Surgery, Atlanta, Georgia, June 8-10, 2000

Address correspondence and reprint requests to: Stephan Schueler, MD, PhD, Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307 Dresden, Germany, Phone: +49 351 450 1801, Fax: +49 351 450 1802, Email: Monika.Weber.hkz_dd@t-online.de

Keywords: Dresden Technique; Bilateral Internal Mammary Artery Grafting, Robotics