RAVECAB: improving outcome in off-pump minimal access surgery with roboticassistance and video enhancement

Objective: To determine the efficacy of using the harmonic scalpel and robo tic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA). Design: A case series. Setting: London Health Sciences Centr e, University of Western Ontario, London, Ont. Patients and methods: Fiftee n consecutive patients requiring harvest of the ITA for coronary artery byp ass grafting. Intervention: Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions,using the harmonic scalpe l and a voice-activated robotic assistant. Main outcome measures: Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization. Results: RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic s calpel in all cases. There were no conversions to a standard approach and n o reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative gra ft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 1 00% graft patency on postoperative angiography. There were no deaths, perio perative myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days. Conclusions: RAVECAB is a demanding pro cedure that addresses many of the disadvantages of the "conventional" minim ally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed un der direct vision through a 5- to 8-cm inferior mammary incision.