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13.11.2017 | Review Article | Sonderheft 2/2018

Indian Journal of Thoracic and Cardiovascular Surgery 2/2018

Robot-assisted totally endoscopic coronary bypass surgery

Indian Journal of Thoracic and Cardiovascular Surgery > Sonderheft 2/2018
Laszlo Göbölös, Jehad Ramahi, Andres Obeso, Thomas Bartel, Mahmoud Traina, Ahmad Edris, Faisal Hasan, Johannes Bonatti


Totally endoscopic coronary artery bypass (TECAB) surgery can exclusively be undertaken with the aid of operative robots. In the past two decades, surgical remote manipulator systems—predominantly the daVinci® devices—have brought us the reality of endoscopic internal mammary artery harvesting and coronary bypass anastomoses via minimally invasive thoracic port access. Single up to quadruple TECAB interventions are recently feasible; the procedure can be delivered either as beating heart applying endoscopic vacuum stabilizer or under cardioplegic arrest on heart-lung machine. Significant surgical team learning curves are involved in a stepwise development of these complex procedures, including intense dry- and wet-lab trainings, endoscopic internal mammary artery harvesting and manual coronary anastomosis building through a thoracotomy. Increasing number of papers have been published regarding clinical TECAB series in the past decade. In arrested heart TECAB procedures on cardiopulmonary bypass, the conversion rate from port access to larger thoracic incision measures 15.1% and no perioperative mortality is observed in published records. Stroke, kidney failure and atrial fibrillation rates stay at 0.6, 0.4 and 12.9%, respectively. Analysis of beating heart TECAB procedures revealed a conversion rate of 15.3%, perioperative mortality 0.4%, stroke 0.3%, kidney failure 0.6% and atrial fibrillation 9.2%. Additionally, due to the obviously smaller surgical trauma, a remarkable fast return to normal daily activities can be demonstrated in clinical series of robotic assisted coronary bypass surgery. Short-term freedom of major adverse cardiac and cerebral events (MACCE) stays over 90%. Long-term studies reveal 5-year freedom of MACCE in the 75.2 to 83.1% range. Nowadays, total endoscopic coronary artery bypass grafting is a feasible and reproducible surgical method. Advanced hybrid coronary interventions offer complex multivessel TECAB with support of percutaneous coronary interventions (PCI). Combination of the above techniques widens the spectrum of minimally invasive therapeutic solutions concerning multivessel procedure including bilateral internal mammary grafts and drug-eluting stents.

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