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Virtual Reality Simulation For Minimally Invasive Coronary Artery Bypass Grafting With Skeletonized In-situ Arterial Grafts
Hakodate Goryoukaku Hospital, Hakodate, Japan.

BACKGROUND:Advancing of the virtual reality (VR) technologies have enabled useful therapeutic guiding in clinical practice. However, it has been controversial how to use VR system in cardiac surgery. We describe the novel simulation system for minimally invasive coronary artery bypass grafting (MICS-CABG) with in-situ arterial grafts.
METHODS: Preoperative stereolithographic files in total 17 in-situ arterial grafts of MICS-CABG were converted by using 320-slice computed tomography. Our strategy of MICS-CABG is directed toward obtaining complete myocardial revascularization using in-situ right internal thoracic artery (RITA), left internal thoracic artery (LITA) and right gastroepiploic artery (GEA). The aim of this study was to clarify the efficacy of VR simulation for MICS-CABG.
RESULTS: There are three main points in using VR simulation. At first, the simulation of graft designs was performed precisely. We can confirm the accurate length and direction of each grafts through the 3-dimentional VR glasses, therefore can use in-situ bilateral internal thoracic artery (BITA) and GEA grafts for MICS-CABG appropriately. The maximum length of in-situ LITA (n=10),RITA (n=4) and GEA (n=3) grafts measured by VR simulation were 26.3mm, 24.1mm and 28.5mm. The length of these required by VR simulation were 21.5mm, 22.5mm and 26.5mm respectively. Secondly, the anatomical form of BITA was confirmed via MICS surgical view. The obstruction of sternum and meandering of BITA grafts were obtained actuality. Therefore, these have enabled harvesting BITA grafts via small left thoracotomy securely. Finally, the perspective sensation of native coronary arteries is verified intuitively, and the best intercostal approach site was detected easily. The early mortality and morbidity were 0%. The patency of grafts was 100%. All patients did not need any transfusions. The most of these patients were extubated in operation room immediately.
CONCLUSIONS:VR simulation can further improve the advantage of MICS-CABG with skeletonized in-situ arterial grafts lower invasively and more safely.

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