Bright Future for Robot-assisted Minimally Invasive Direct CABG
Dr. N. Ishikawa from the Department of General and Cardiothoracic Surgery, Kanazawa University, Japan, wanted to assess the outcome of robot-assisted minimally invasive direct coronary artery bypass grafting (MIDCAB), which is also termed “ThoraCAB.”
In 35 consecutive patients who underwent MIDCAB via a small thoracotomy on a beating heart from 2005 to 2013, their internal thoracic arteries (ITAs) were endoscopically harvested through three ports using the da Vinci Surgical System in a completely skeletonized fashion before performing MIDCAB. The distal anastomosis was hand-sewn using a vacuum stabilizer. Flow was measured post-anastomosis using a Transonic intraoperative flowprobe.
An average of 1.7 ± 0.8 grafts (range, 1-3 grafts) per patient were placed in each patient. No patient needed mechanical ventilation for more than 24 hours. No patient required conversion to median sternotomy, and there were no deaths, strokes or myocardial infarctions.
Dr. Ishikawa concluded that robot-assisted ITA harvesting is safe and feasible, and that ThoraCAB is a relatively simple procedure and allows multivessel bypass grafting through a small thoracotomy. Therefore, he expects that ThoraCAB will become the standard procedure for minimally invasive coronary revascularization and will be used in totally endoscopic CABG in the future.
References: Ishikawa N, Watanabe G, Tomita S, Yamaguchi S, Nishida Y, Iino K, “Robot-assisted minimally invasive direct coronary artery bypass grafting. ThoraCAB,” Circ J. 2014; 78(2): 399-402. (Transonic Reference # 10555AH)