Wrist-enhanced instrumentation: Moving toward totally endoscopic coronary artery bypass grafting

Background. With the introduction of the da Vinci robotic surgical system ( Intuitive Surgical, Mountain View, CA) into minimally invasive cardiac oper ations the outlook for performing coronary artery bypass operations "closed chest" became a reality. Methods. Between May 1999 and December 1999 this new wrist-enhanced instrum entation was used in 61 patients. Six patients suffering from single-vessel coronary artery disease and one female patient with double-vessel disease underwent totally endoscopic coronary artery bypass. Thirty-seven patients with single-vessel disease underwent a minimally invasive direct coronary a rtery bypass procedure. Seventeen patients with double-vessel disease were treated using the robotic-enhanced Dresden technique. Results. Perioperative survival was 100%. In all patients the internal mamm ary arteries were safely harvested endoscopically and had excellent quality . In both totally endoscopic coronary artery bypass groups all patients wer e operated on through three stab incisions. Conclusions. Our preliminary experience with this new surgical technique us ing robotic-enhanced minimally invasive methods for coronary artery disease promotes optimism regarding further development of these procedures and ap plication in patients with coronary artery disease. (Ann Thorac Surg 2000;7 0:1105-8) (C) 2000 by The Society of Thoracic Surgeons.