International Society For Minimally Invasive Cardiothoracic Surgery

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Lita Assessment By Fireflyfluorescence Imaging In Robotic Assisted Midcab
Yoshitsugu Nakamura, Miho Kuroda, Yujiro Ito, Takaki Hori, Takahiko Masuda, Takahisa Hirano, Yasuhito Okuzono, Syuhei Nishijima.
Chibanishi general hospital, Chiba, Japan.

Objective: the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) cannot give tactile feedback to surgeons. This shortcoming may increase the risk of left internal thoracic artery (LITA) injury during its harvest. We utilized Firefly Fluorescence Imaging (Firefly) to assess LITA quality in robot assisted minimally invasive direct coronary artery bypass (R-MIDCAB). Methods: We retrospectively reviewed clinical records and intraoperative video of 30 patients who underwent R-MIDCAB with LITA- left anterior descending (LAD) coronary bypass. All patients had post-harvest assessment of LITA blood flow by Firefly with 1 ml (2.5mg/ml) of indocyanine green injection through a central line. Results: Twenty seven of the patients were male, mean age was 67.7 +/-10.7 (SD) years. In post-harvest assessment performed before transection of the distal LITA, blood flow in LITA was well visualized in 28 patients. In the remaining two patients, one had dissection and the other had severe spasm of the LITA. Firefly was also useful for locating LITA and LAD and for assessing blood flow of the graft after anastomosis. Time required for each Firefly assessment was approximately 20 seconds. There were no side-effects nor complications due to Firefly intra- and postoperatively. Twenty six patients had postoperative coronary computed tomography; LITA patency rate was 100% (26/26). Conclusion: Firefly is fast, simple and effective for locating and assessing flow in LITA and LAD before and after anastomosis in R-MIDCAB.


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