Learning Curve In Endoscopic Mammary Artery Harvesting Using High Definition 3d Camera
Maria Cannoletta, Richard Trimlett, Anthony De Souza.
Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
BACKGROUND: Endoscopic mammary artery harvesting is a fundamental step in development of endoscopic and robotic-assisted techniques for minimally invasive bypass grafting. This procedure is still only performed in highly specialised centres with few surgeons training in endoscopic harvest given the challenges with conventional two dimensional(2D) imaging. We believe that three dimensional imaging can improve and facilitate mammary artery harvesting training with less complications. METHODS: Between January 2019 and November 2021, 214 patients underwent EndoACAB (atraumatic endoscopic coronary artery bypass grafting) at our institution. The LIMA was harvested endoscopically through 3-port access and with the aid of a robotic arm (AESOP: Automated Endoscopic System for Optimal Positioning), a harmonic scalpel and the Braun 3D HD system. In 85 of this, mammary artery harvesting was performed by a surgeon in training and in 68 of these, intraoperative time of port positing and harvesting time were recorded.RESULTS: The mean port insertion + LIMA harvest time was 47.5 ± 17.3 minutes. This steadily decreased with the increasing number of cases performed as displayed graphically in table 1 and 2. In the last ten cases, the average time was down to 30+/-11min.
There were no complications of LIMA damage or major bleeding and in all cases the LIMA had good flow and was used to graft the LAD.CONCLUSIONS: In minimally invasive coronary artery bypass surgery, mammary artery harvesting is an important step of training. Learning curve can be facilitated by three dimensional imaging with excellent results in terms of safety and low risk of damage to the mammary artery with improved harvest times comparable to open harvest. 
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