Use of the voice-controlled and computer-assisted surgical system ZEUS forendoscopic coronary artery bypass grafting

Objective: With the aim of performing a completely endoscopic coronary bypa ss anastomosis, we have undertaken an experimental and clinical study using robotic instrumentation and voice-controlled camera guidance, Methods: The ZEUS Robotic Surgical System (Computer Motion Inc, Goleta, Calif) consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled down mode, The third arm (AESOP, C omputer Motion) positions the endoscope via voice control. Phase I: In a ph antom model, vascular grafts were anastomosed to the left anterior descendi ng coronary artery (LAD) of 50 pig hearts with either 2- or 3-dimensional v isualization, Phase II: In 6 dogs (FBI 20-25 kg) the left internal thoracic artery (LITA) was harvested endoscopically, Then the animals were placed o n an endovascular cardiopulmonary bypass system (Port-Access, Heartport, In c, Redwood City, Calif), Anastomosis of the LITA to the LAD was performed e ndoscopically with the telemetric ZEUS instruments, Flow rates through the LITA were measured by Doppler analysis, Phase III: Two patients were operat ed on with the ZEUS system, After endoscopic harvesting of the LITA and car diopulmonary bypass with the Port-Access system, the bypass graft (LITA-LAD ) was anastomosed endoscopically with the ZEUS system through three thoraci c ports. Results: In the dry laboratory, the time range required for the ro botically assisted coronary anastomosis was 35 to 60 minutes with 2-dimensi onal visualization and 16 to 32 minutes with 3-dimensional visualization, I n the animal experiments, the median time for endoscopic harvesting of the LITA was 86 minutes (range 56-120 minutes) and for the anastomosis, 42 minu tes (range 35-105 minutes); flow rates through the LITA ranged between 22 a nd 45 mL/min. In the clinical cases, preparation times for the LITA were 83 and 110 minutes, respectively, and anastomosis times, 42 and 40 minutes, r espectively. Doppler flow rates measured 125 and 85 mL/min, respectively. B oth patients had an uneventful follow-up angiogram and postoperative course . Conclusions: With sophisticated robotic technology, a completely endoscop ic anastomosis of the LITA to the LAD is possible, allowing technically pre cise operations within acceptable time limits.