Experiences in robotically enhanced IMA-preparation as initial step towards totally endoscopic coronary artery bypass grafting

Cardiovascular surgery (London, England) Pub Date : 2003-12-01 DOI:10.1016/S0967-2109(03)00114-5

O Reuthebuch, M Comber, J Grünenfelder, G Zünd, M Turina

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Abstract

Aim: To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA).

Method: Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO₂ insufflation and single lung ventilation using electrocautery.

Results: In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7±1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7±21.1 and 99.2±8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9±13.1 s, clip applier 72.8±28.4 s).

Conclusion: Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.

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机器人增强ima准备作为全内窥镜冠状动脉旁路移植术的第一步的经验

目的:探讨机器人增强乳腺内动脉预备术的可行性。方法:在CO2灌注和单肺通气的情况下，采用电灼法对左、右或双侧IMA进行骨化。结果:12个月内，共切除LIMA 26例，BIMA 5例，RIMA 1例。在5例患者中，必须确定手术方法(2例IMA损伤，2例呼吸功能不全，1例心脏穿透)。平均胸内压为9.7±1.5 mmHg。LIMA和RIMA的平均解剖时间分别为66.7±21.1 min和99.2±8.7 min。10例患者切开心包，评估LAD病程。然而，在2例患者中，冠状动脉与LAD无关。换刀时间随刀具类型的不同而不同(烧灼刀:24.9±13.1 s，夹钳:72.8±28.4 s)。结论:机器人切割IMA是合理的。然而，由于工具不足和更换器械的时间过长，危及生命的并发症几乎无法得到控制。不正确的冠状动脉测定可导致吻合错位。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Cardiovascular surgery (London, England)

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