Prospective Angiographic Comparison of Direct, Endoscopic, and Telesurgical Approaches to Harvesting the Internal Thoracic Artery

Bob Kiaii, R. Scott McClure, Larry Stitt, Reiza Rayman, Wojciech B. Dobkowski, George Jablonsky, Richard J. Novick, Walter D Boyd

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques. Methods: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency. Results: Average left internal thoracic artery harvest times were 23 ± 2.5, 63.3 ± 20.3, and 66.1 ± 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 ± 11.9, 33.7 ± 19.3, and 36.9 ± 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall). Conclusions: The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.

Original languageEnglish (US)
Pages (from-to)624-628
Number of pages5
JournalAnnals of Thoracic Surgery
Volume82
Issue number2
DOIs
StatePublished - Aug 2006
Externally publishedYes

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Mammary Arteries
Off-Pump Coronary Artery Bypass
Robotics
Computer Systems
Myocardial Revascularization
Sternotomy
Operative Time
Coronary Artery Disease
Angiography
Morbidity
Transplants
Equipment and Supplies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Prospective Angiographic Comparison of Direct, Endoscopic, and Telesurgical Approaches to Harvesting the Internal Thoracic Artery. / Kiaii, Bob; McClure, R. Scott; Stitt, Larry; Rayman, Reiza; Dobkowski, Wojciech B.; Jablonsky, George; Novick, Richard J.; Boyd, Walter D.

In: Annals of Thoracic Surgery, Vol. 82, No. 2, 08.2006, p. 624-628.

Research output: Contribution to journalArticle

Kiaii, Bob ; McClure, R. Scott ; Stitt, Larry ; Rayman, Reiza ; Dobkowski, Wojciech B. ; Jablonsky, George ; Novick, Richard J. ; Boyd, Walter D. / Prospective Angiographic Comparison of Direct, Endoscopic, and Telesurgical Approaches to Harvesting the Internal Thoracic Artery. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 2. pp. 624-628.
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abstract = "Background: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques. Methods: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency. Results: Average left internal thoracic artery harvest times were 23 ± 2.5, 63.3 ± 20.3, and 66.1 ± 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 ± 11.9, 33.7 ± 19.3, and 36.9 ± 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall). Conclusions: The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.",
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AU - Kiaii, Bob

AU - McClure, R. Scott

AU - Stitt, Larry

AU - Rayman, Reiza

AU - Dobkowski, Wojciech B.

AU - Jablonsky, George

AU - Novick, Richard J.

AU - Boyd, Walter D

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AB - Background: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques. Methods: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency. Results: Average left internal thoracic artery harvest times were 23 ± 2.5, 63.3 ± 20.3, and 66.1 ± 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 ± 11.9, 33.7 ± 19.3, and 36.9 ± 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall). Conclusions: The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.

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