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Robotic IMA Harvesting CABG Protocol from Dr. Francis Sutter

By Tim Callahan27 Sep 2021

Dr. Francis Sutter has performed more robotic-assisted CABG surgeries than any other surgeon in the country, according to Mainline Health.

A traditional CABG procedure can be tough on the patient, Sutter noted, which is why he uses robotic tools. Screen Shot 2021-09-24 at 10.42.50 AM

“Using a robot to perform heart surgery can make an enormous difference in how much impact the surgery has on a person during and after their operation. But robotic surgery is just a tool.” 

He continued, “And like every other surgical tool going back to the first scalpel, it is dependent on practice and a skilled user to achieve the best results. That is why I strive to be the best robotic cardiac surgeon I can be. I know that surgical excellence is rooted in one basic principle, which is to improve on the current way of doing things by making surgery safer and easier for the patient,” he said.

This was one of the reasons Sutter became an early adopter of robotic cardiac surgery. In traditional surgery, the patient receives a 10-inch incision and their breast bone is cracked to access the heart. Then, the patient is connected  to the heart-lung machine while their heart is stopped for the procedure. 

With robotic cardiac surgery, the patient receives a 1.75-inch incision and can return to their normal daily activities in around two weeks. Additional benefits to the patient include:

  1. Less postoperative pain
  2. Reduced risk of stroke
  3. Avoidance of blood clots

Sutter uses Transonic measurement tools during his robotic cardiac surgery procedures, and as one of the first surgeons to adopt robotic technology for CABG procedures, has created a protocol for using Transonic measurements during these procedures.

Measuring Bypass Flow During Robotic CABG with Transonic Tools

Select Correct Perivascular Flowprobe Size: Using agauge, determine  the diameters of the vessel(s) to be measured before opening the flowprobe package. Select a flowprobe size so that the vessel will fill between 75% - 100% of the flowprobe ultrasonic sensing window.

Prepare Vessel for Flowprobe: Determine the optimal location  for applying the flowprobe by selecting a site wide enough to accommodate the Flowprobe acoustic reflector. Clear approximately 1 cm of the vessel of extraneous tissue (i.e. fascia, fat). 

Add Couplant to Flowprobe: Fill the flowprobe window with ultrasonic gel or submerge the flowprobe head in saline in the surgical field. 

Apply Flowprobe: Apply the flowprobe perpendicular to the vessel taking care not to “twist” or “lift” the vessel with the probe. Apply the flowprobe so that the entire vessel lies within the ultrasonic sensing window of the flowprobe. 

Check Signal Strength: Check the  ultrasonic signal strength on the Flowmeter Signal Quality Indicator. If the acoustic signal  falls below an acceptable value, an acoustic error message will be displayed. 

Measure Flow

Assess Flow per the Transonic CABG Patency Assurance Protocol. 

Document Flows for Case Record if Desired.  

For more about these robotic IMA harvesting CABG protocol, click here

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