ROBOTICALLY ASSISTED MICROSURGERY FOR ENDOSCOPIC CORONARY-ARTERY BYPASS-GRAFTING

Background. As minimally invasive approaches to cardiac surgery have e xpanded, a significant number of limitations have become apparent, par ticularly the lack of adequate precision with standard endoscopic inst ruments. We hypothesized that the use of robotics would eliminate some of these limitations. Methods. Twenty-five coronary anastomoses on an isolated porcine heart, using an arterial conduit to the left anterio r descending artery, were performed endoscopically with a microsurgica l robotic system. Sophisticated robotic engineering was used to contro l modified endoscopic instruments under direct surgeon control. Comput er tremor elimination and motion scaling allowed for precise maneuveri ng. An arteriotomy was placed in the left anterior descending artery, and an arterial conduit was positioned for anastomosis. The camera and port sites were placed 90 degrees from the long axis of the arterioto my. A 7-0 Prolene (Ethicon, Somerville, NJ) suture was used to perform the anastomosis in a continuous fashion, begun at the 12 o'clock posi tion and continued counterclockwise. After completion of half of the a nastomosis, the conduits were pulled down and the final sutures were p laced. The sutures were tied intracorporeally and the procedure was co mpleted. Results. The 25 conduits were successfully completed and show ed good probe patency. Average time for completion of the anastomosis was 31.7 +/- 2.0 minutes. Appropriate port placement and orientation, and stabilization of the conduits were critical. The lack of tremor an d motion scaling allowed for the precise movements needed to complete an endoscopic microvascular anastomosis. Conclusions. Coronary artery anastomoses are technically feasible with use Of robotic instrumentati on. This technology may enable the development of a truly endoscopic a pproach to bypass surgery.