Development of a robotic coronary artery bypass surgery program

Aims: In 2004, our robotic coronary artery bypass surgery program was launched. This report exposes our step-by-step approach, aimed to avoid increased mortality or morbidity during the learning curve.

Methods: From 04/2004 to 08/2006, a total of 62 robotically-assisted procedures were performed using the daVinci telemanipulator system. First, endoscopic LIMA harvest was performed (n=11) with subsequent OPCAB surgery. During the next step, following LIMA takedown, the pericardium was opened endoscopically to expose the LAD. If a sufficient vessel diameter and quality was found, a robotic-enhanced MIDCAB (RE-MIDCAB) procedure through a left anterior minithoracotomy was performed (n=24). Otherwise, the operation was completed using a complete (n=22) or partial (n=1) sternotomy on the beating heart. Two-vessel bypass surgery through a minithoracotomy with a LIMA-Radial T-graft (n=4) was performed using the Starfish-NS Heart Positioner. Two patients were excluded due to pleural adhesions.

Results: There was no hospital mortality. The time for LIMA harvest could be significantly reduced with increasing practice from 90min. to 43min. (p<0.01). Surgery time, ICU stay, and hospitalization after RE-MIDCAB surgery were 245±46min., 44±27h, and 5.8±1.3 days. The last 10 patients could be discharged after 4 days. Due to the intraoperative visualization and assessment of the target vessel, no conversions to sternotomy were necessary in RE-MIDCAB patients. There was one early rethoracotomy for IMA sidebranch bleeding (patient #4). No severe postoperative complications, no wound infections, or neurological dysfunction could be detected.

Conclusions: Using our stepwise approach, robotic coronary artery bypass surgery can be safely implemented into a heart surgery program.