A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis

Background. New technology has enabled surgeons to attempt totally endoscop ic coronary artery bypass grafting. Our purpose was to compare three differ ent techniques of totally endoscopic anastomosis using a porcine animal mod el. Methods. Porcine hearts were excised and the right coronary artery was diss ected free for use as an arterial graft. The hearts were placed in a human thoracic model and an endoscopic arterial anastomosis between the free righ t coronary artery and the left anterior descending coronary artery was perf ormed using one of the following: (1) two-dimensional visualization with st raight endoscopic instruments (n = 8); (2) three-dimensional head-mounted v isualization with curved endoscopic instruments (n = 7); or (3) three-dimen sional visualization with robotic telemanipulation (n = 8). Pathologic anal ysis of suture placement, vessel trauma, and patency was performed. Anastom oses were graded according to quality, ease, and patency using a seven-poin t Likert scale (1 = excellent, 7 = very poor). Results. Endoscopic anastomotic ease and quality were significantly improve d when three-dimensional visualization and curved endoscopic instruments we re employed. Telemanipulation enhanced the process and provided the best op erative results with regard to time required to construct the anastomosis, as well as ease and quality. Conclusions. Totally endoscopic anastomosis is feasible using currently ava ilable technology. Three-dimensional visualization and robotic telemanipula tion significantly facilitate anastomosis construction and will likely bene fit clinical operative outcome. (Ann Thorac Surg 2000;70:839-43) (C) 2000 b y The Society of Thoracic Surgeons.