Background : Robotic systems have opened the era of endoscopic cardiac surgery. Still the reports of totally endoscopic coronary bypass are very scarce. Therefore we report our early experience of totally endoscopic CABG.
Methods : Totally endoscopic mammary-to-LAD grafting was attempted in 25 patients, with the Da Vinci system. The first group (n=12) was due to arrested heart with the Heartport technique and the second, consecutive, group (n=13) was operated on the beating heart with endoscopic mechanical stabilization.
Results : In the arrested heart group, 5 patients were converted to either sternotomy (n=2) or MIDCAB (n=3), all for 'Heartport-related' technical reasons. 7 were performed totally endoscopically. In the beating heart (BH) group, 2 patients were converted to MIDCAB for excessive backbleeding from the anteriotomy site hindering proper visualization and stitching, 2 for unsatisfactory stabilization, and one for ventricular fibrillation. 8 were totally endoscopic.
At a mean follow-up of 8 ± 3 months all patients are asymptomatic.
Conclusion :
1. (BH)TECAB is doable without undue morbidity after a short learning curve at the price of a significant conversion rate.
2. The use of the Heartport system has unexpectedly been a major source of conversion in the arrested heart cohort.
3. Ancillary instruments such as an improved endostabilizer, blower/mister and 4th robotic arm are requested to facilitate the procedure and enhance its reproducibility.
4. By avoiding sterno-/thoracotomy, aortic manipulations and CPB, BHTECAB theoretically carries the lowest possible invasiveness of coronary surgery. Therefore it deserves further development under careful scrutiny.