Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: Report of forty-five cases
Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: Report of forty-five cases
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DOI：
10.1067/mtc.2002.121305
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发表时间：
2002-06-01
影响因子：
6
通讯作者：
Wimmer-Greinecker, G
中科院分区：
文献类型：
--
作者：
Dogan, S;Aybek, T;Wimmer-Greinecker, G
背景：机器人增强远程操作是一种新的强大的微创手术工具，可以实现全内窥镜心脏手术。在1999年6月至2001年2月间，我们使用达芬奇遥控操作系统（Intuitive Surgical, Inc, Mountain View, california）对45例停搏心脏进行了机器人增强全内窥镜冠状动脉旁路移植术。方法：对37例患者行单支全内窥镜冠状动脉搭桥手术。8例患者有不同类型的双胸内动脉多血管重建术。最初的转换率为22%，在最后20例患者中下降到5%。2例患者需要通过正中胸骨切开术重新探查。前22例患者出院时移植物通畅良好。单血管全内镜旁路手术时间4.2 +/- 0.4小时，旁路时间136 +/- 11分钟，主动脉交叉夹持时间61 +/- 5分钟。结论：本研究资料显示闭式胸腔单、双血管重建术的可行性，具有良好的临床效果。然而，手术时间延长，需要复杂的内镜和主动脉内闭塞技术，以及广泛的麻醉监测。在相对较短的学习曲线后，转向开放式手术的需要减少了。除了良好的美容效果外，全内窥镜手术的所有假定益处必须在更大的队列中进行评估。
Background: Robotically enhanced telemanipulation is a new powerful tool for minimally invasive procedures that allows totally endoscopic cardiac surgery. Between June 1999 and February 2001, 45 robotically enhanced totally endoscopic coronary artery bypass grafting procedures on the arrested heart were performed at our institution With the use of the da Vinci telemanipulation system (Intuitive Surgical, Inc, Mountain View, Calif).Methods: In 37 patients a single-vessel totally endoscopic coronary bypass operation Was performed. Eight patients had different types of multivessel revascularization with both internal thoracic arteries. The initial conversion rate was 22% and dropped to 5% in the last 20 patients. Two patients required reexploration via median sternotomy. The first 22 patients had excellent graft patency on discharge. The procedural time for single-vessel totally endoscopic bypass was 4.2 +/- 0.4 hours, bypass time was 136 +/- 11 minutes, and aortic crossclamp time amounted to 61 +/- 5 minutes.Conclusion: The present data show the feasibility of closed chest single- and double-vessel revascularization, With good clinical results. However, Procedural time is prolonged and the complex endoscopic and endoaortic occlusion techniques, as Well as the extensive anesthesiologic monitoring, are demanding. The need for conversion to an open procedure diminished after a relatively short learning curve. All postulated benefits of totally endoscopic surgery other than excellent cosmesis must be evaluated in larger cohorts.