Computer-assisted coronary surgery: lessons from an initial experience

摘要

Robotic-enhanced coronary surgery has been performed on sixty consecutive unselected patients (60.8+/-12 years) requiring CABG only. Nine had single-vessel (LAD), 13 double-vessel, and 38 triple-vessel disease. Since the endostabilizer was made available in the autumn of 2002 only, the first 47 patients were proposed to have closed chest LIMA dissection only. This was achieved successfully in all but one patient. In addition, 12 distal anastomosis have been performed after full sternotomy with the robot. Every other anastomosis has been hand sewn. The last 13 patients were TECAB candidates. After successful LIMA harvesting, LIMA to LAD suture has been attempted in totally closed chest on the beating heart: it has been successful in two only, the remaining lesions (a total of three) being dilated and stented the day after surgery. In the other 11 patients, the coronary anastomosis was hand sewn after full sternotomy. This suggests that the difficulties in anastomosing small vessels with a standard suture technique jeopardizes the reproducibility of the technique and that further technological developments are needed, to make robotic surgery safe and attractive for the patients.