Robotic-enhanced Dresden technique for minimally invasive bilateral internal mammary artery grafting

BACKGROUND: The introduction of robotic-enhanced endoscopic instrumentation systems allows the surgeon to perform arterial revascularization for multi vessel coronary artery disease without sternotomy. METHODS: From April 1999, 27 patients (6 female, 21 male, median age 63 +/- 8.2 years) suffering from multivessel coronary artery disease were treated surgically using arterial revascularization by means of bilateral internal mammary artery (BIMA) grafting. Both arteries were harvested totally endos copically using the da Vinci (TM) robotic surgical system (Intuitive Surgic al, Mountain View, CA). These vessels were anastomosed using the "Dresden T echnique" via a left minithoracotomy in the second intercostal space. RESULTS: All patients survived the operation. The mean duration of surgery was 240 +/- 79.4 minutes. Bilateral internal mammary artery harvesting time was 88.5 +/- 15.9 minutes, and cross-clamp time was 38 +/- 10.9 minutes. A n average of 2.07 anastomoses were performed per operation. Postoperatively , the patients remained in ICU for 20 +/- 2.4 hours. One patient needed ree xploration due to bleeding. CONCLUSIONS: Bilateral internal mammary artery harvesting can be achieved s afely with the use of wrist-enhanced instrumentation. The robotic surgical system introduces into surgical practice a new type of treatment of coronar y artery disease, helping to perform arterial revascularization with a dist inctly reduced surgical trauma.