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(Circulation. 2001;104:I-102.)
© 2001 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Development of Robotic Enhanced Endoscopic Surgery for the Treatment of Coronary Artery Disease

Utz Kappert, MD; Jens Schneider, MD; Romuald Cichon, MD; Vassilios Gulielmos, MD; Sems-Malte Tugtekin, MD; Joachim Nicolai, MD; Klaus Matschke, MD; Stephan Schueler, MD,PhD

From the Departments of Cardiovascular Surgery (U.K., J.S., R.C., V.G., S.-M.T., K.M., S.S.) and Anesthesiology (J.N.), Cardiovascular Institute, University of Dresden, Germany.

Correspondence to Utz Kappert, MD, Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307 Dresden, Germany. E-mail Monika.Weber.hkz_dd{at}t-online.de

Background— The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team.

Methods and Results— Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64±10.5 years, left ventricular ejection fraction 68±12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (n=156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (n=37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (n=8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration.

Conclusions— The introduction of this new surgical tool enables the development of new endoscopic procedures. Our results gained during the development of robotic enhanced CABG motivate us to establish a set standard for the totally endoscopic treatment of patients with 1-vessel coronary artery disease.

Key Words: robotics • bypass • endoscopy • surgery • arteries