Abstract
Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 ± 17.9 minutes, 28.5 ± 28.2 minutes, and 368 ± 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 101-109 |
| Number of pages | 9 |
| Journal | Seminars in Thoracic and Cardiovascular Surgery |
| Volume | 14 |
| Issue number | 1 |
| State | Published - 2002 |
| Externally published | Yes |
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Keywords
- Minimally invasive surgery
- Robotics
- Telesurgery
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery. / Boyd, Walter D; Kodera, Kojiro; Stahl, Kenneth D.; Rayman, Reiza.
In: Seminars in Thoracic and Cardiovascular Surgery, Vol. 14, No. 1, 2002, p. 101-109.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery
AU - Boyd, Walter D
AU - Kodera, Kojiro
AU - Stahl, Kenneth D.
AU - Rayman, Reiza
PY - 2002
Y1 - 2002
N2 - Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 ± 17.9 minutes, 28.5 ± 28.2 minutes, and 368 ± 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
AB - Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 ± 17.9 minutes, 28.5 ± 28.2 minutes, and 368 ± 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
KW - Minimally invasive surgery
KW - Robotics
KW - Telesurgery
UR - http://www.scopus.com/inward/record.url?scp=0036245924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036245924&partnerID=8YFLogxK
M3 - Article
C2 - 11977023
AN - SCOPUS:0036245924
VL - 14
SP - 101
EP - 109
JO - Seminars in Thoracic and Cardiovascular Surgery
JF - Seminars in Thoracic and Cardiovascular Surgery
SN - 1043-0679
IS - 1
ER -