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How I Did My First Beating Heart TECAB LIMA/RIMA Y-graft To LAD And OM In The Absence Of A Robotic Endo-stabilizer
Johannes Bonatti1, Andrea Amabile1, Kei Kobayashi1, Nicholas Hess1, Martin Winter1, Noah Rolleri2, Jared Romeo1.
1University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute, Pittsburgh, PA, USA, 2University of Pittsburgh School of Medicine Department of Anesthesiology and Perioperative Medicine, Pittsburgh, PA, USA.
BACKGROUND: Robotic totally endoscopic coronary artery bypass grafting (TECAB) on the beating heart is currently restricted by the unavailability of a robotic endo-stabilizer for the fourth generation of surgical robots. Several workarounds have recently been presented including use of the Octopus NuvoTM device though a subcostal mini-incision or use of the old Octopus TE TM device. Stabilizers connected to classic robotic instruments inside the chest have also been reported.
METHODS: In this video a technique is presented using a robotic long-tip forceps and pump support for immobilization of the coronary targets. A Y-graft constructed with LIMA and RIMA was anastomosed robotically to the LAD and to an OM branch. The procedure was performed on the beating heart with pump support.
RESULTS: LIMA to LAD flow was 41 ml/min with a PI of 0.3, RIMA to OM flow was 78 ml/min with a PI of 0.3. The patient's ICU stay was 48 hours and the hospital stay was 5 days without complications.
CONCLUSIONS: Beating heart multi-vessel TECAB including grafts to the obtuse marginal branches is feasible using a robotic long-tip forceps for mechanical stabilization of the coronary arteries. Pump support may be necessary for adequate exposure and immobilization of the target vessels. It is important to note that the method shown is a workaround and cannot completely replace a proper robotic suction endo-stabilizer. Robotic device companies are strongly encouraged to produce such an instrument for the new generation of surgical robots.
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