Background. This multicenter prospective trial was designed to assess the s
afety and efficacy of using a robotically-assisted microsurgical system to
create endoscopic coronary anastomoses.
Methods. Thirty-two patients scheduled for elective primary coronary surger
y underwent endoscopic anastomosis of the left internal thoracic artery (LI
TA) to the left anterior descending (LAD) artery. Three thoracic ports (two
for instruments and one for a camera) were placed, and a robotic system wa
s used to perform the LITA-LAD graft. Conventional techniques were used to
perform the other grafts. Thirty-one patients underwent median sternotomy a
nd 1 patient underwent a limited anterior thoracotomy.
Results. Graft flow was measured in the operating room and averaged 37 +/-
19 mL/min. Mean anastomosis time was 24 +/- 9 minutes. There were three int
raoperative revisions (9%). Two were for inadequate flow and one for an ina
dvertent injury. Each of these grafts was successfully revised by hand. The
re were no technical failures of the robotic system. Average postoperative
length of stay was 5.5 +/- 2.7 days. There were three reoperations for blee
ding, but none of these were related to the LAD anastomosis. Two months fol
lowing the operation, selective angiography revealed a graft patency of 93%
. The patients have been followed for 16 +/- 4 months.
Conclusions. This initial prospective multicenter trial documents the feasi
bility of robotically-assisted coronary bypass grafting. Further trials are
warranted to establish the safety and efficacy of this new technology. (C)
2001 by The Society of Thoracic Surgeons.