The Heart Surgery Forum, Volume 6, Issue 4

A Porcine Beating Heart Model for Robotic Coronary Artery Surgery

(#2003-21386 . . . April 29, 2003)

Harry W. Donias, MD,¹ Ted Schwartz, MD,² Daniel G. Tang, MD,³ Abe DeAnda, Jr., MD,⁴ Harold A. Tabaie, DO, PhD,⁵ Douglas W. Boyd, MD,7 Hratch L. Karamanoukian, MD¹,6,8

¹Department of Surgery and 6Division of Cardiothoracic Surgery, State University of New York at Buffalo, Buffalo, New York; ²Computer Motion, Inc, Goleta, California; ³Department of Surgery and ⁴Division of Cardiothoracic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia; ⁵Center for Advanced Surgery, Sarasota Memorial Healthcare System, Sarasota, Florida; 7Cleveland Clinic Florida, Weston, Florida; 8Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery at the Buffalo General Hospital, Buffalo, New York, USA

ABSTRACT

Background: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis.

Methods: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test.

Results: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical signifi- cance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P < .0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P = .0049).

Conclusions: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

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