Totally endoscopic coronary artery bypass on the beating heart

Our aim was to develop a technique for totally endoscopic coronary artery b ypass on the beating heart for patients with coronary artery disease. For t his procedure, operations were performed through four thoracoports. The lef t internal thoracic artery (LITA) was harvested thoracoscopically, The peri cardium was then opened and the left anterior descending artery (LAD) ident ified. The endoscopic stabiliser was inserted and transformed into a coiled ring shape. After suction, sufficient immobilisation of the LAD was achiev ed. The proximal snare was placed using a 5-0 Prolene suture to give a bloo dless field. After blunt dissection of the coronary artery, an arteriotomy was performed with a sharp blade and enlarged with endoscopic Potts scissor s. Using an endoscopic needle holder and forceps via two thoracoports at th e fourth intracostal space, a conventional end-to-side anastomosis was safe ly created with an 8-0 Prolene single running suture. Total endoscopic beat ing-heart bypass grafting, including ITA harvest, stabilisation, arteriotom y and performance of the anastomosis, was performed successfully in three p atients. There were no intraoperative arrhythmias, and no postoperative hae morrhage. The patients required no intensive care management postoperativel y. All patients were ready for discharge on the fourth postoperative day. P ostoperative angiogram revealed that anastomoses are patent. We conclude th at the endoscopic stabiliser can sufficiently immobilise the heart to enabl e endoscopic beating-heart coronary artery bypass grafting by means of an e asily controllable instrumentation system.