Robotically assisted totally endoscopic coronary artery bypass surgery

Abstract

Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the "best of both worlds" from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations.

Keywords: Minimally invasive; coronary artery bypass surgery; robotic.

Figure 1

Left internal mammary harvesting.

Figure 2

Opening of coronary with endoscopic knife.

Figure 3

Coronary arteriotomy with endoscopic Pott scissors.

Figure 4

First stitch in the coronary, going from inside to outside, on the toe side.

Figure 5

First stitch in the mammary, going from inside to outside.

Figure 6

Suture of the back wall of the anatomosis.

Figure 7

Putting tension on suture of back wall.

Figure 8

Suture comes to the heel.

Figure 9

Suture of the front wall of the anastomosis.

Figure 10

Last stitch of the anastomosis.

Figure 11

Final result.