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International Society For Minimally Invasive Cardiothoracic Surgery

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Robotically Assisted Minimally Invasive Approach For Off-pump Multi-vessel Revascularizaion: Rationale, Technique And Experience
Rong Wang, Ming Yang, Mingyan Wang, Nan Cheng, Huajun Zhang, Yi Guo, Bing Liu.
PLA General Hosptial, Beijing, China.

OBJECTIVE: The advantage of robotically assisted minimally invasive approach for single vessel disease has been well documented and widely accepted for its easiness of harvesting internal mammary artery and reliable mid-term graft patency. However, the application of this advantage to multi-vessel revascualrization through minimally invasive approach has not been fully investigated. We retrospectively reviewed our early experience with robotically assisted IMA harvesting and off-pump multi-vessel revascuarizaiton through minimally invasive approach with LIMA/RIMA-SVG composite graft . METHODS: From August 2018 to December 2019, 31 patients(22 male and 9 female, average age 6110 years, 35.5% with diabetes) underwent robotically assisted IMA harvesting (LIMA/BIMA) and multi-vessel revascuarizaiton through 8-10cm left thoracotomy minimally invasive approach with LIMA/RIMA-SVG composite graft (Y or I-composite graft). Perioperative outcomes were analyzed. RESULTS: Among the 31 patients, robotically BIMA harvesting was used in 17 (54.8%) patients including 10 patients with a RIMA-SVG composite "I" grafts. LIMA-SVG/RIMA composite "Y" graft was used in 15 patients(48.4%). An average of 2.30.5 grafts were used in the operations. Double, triple, and quadruple MICSCABG was performed in 24(77.4%),6(19.4%), and one(3.2%) patients, respectively. There was no hospital mortality or conversion to conventional CABG and all the LIMA or BIMA were harvested uneventfully with good blood flow (21.211.5ml/min). The blood loss during surgery was 129147ml. One post-operative death (3.2%) due to infection and one case of TIA (3.2%) was noted. All other patients (93.5%) were discharged uneventfully and remained well to this day. CONCLUSIONS: Robotically assisted LIMA/BIMA harvesting and off-pump multivessel revascuarizaion through minimally invasive approach is safe and feasible. With LIMA/RIMA-SVG"Y"or "I" composite graft, the advantage of robotic system in havesting IMA was fully utilized and the challenge of completing the proximal anastomosis was resolved with a real "no-touch" technique. Long-term follow-up is warranted to investigate the graft patency and clinical result.


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