From September, 2000 till May, 2002 thirty-one patients with coronary artery disease have been treated in our center with robotically assisted CABG. 24 patients were male, 7 were female. Mean age was 57.4 (range: 39-74).
In 1 patient the intention of the treatment was a robotically enhanced MIDCAB (take-down of the mammary artery with the robot, followed by a MIDCAB).
In the 30 other patients the intention of the surgical strategy was to perform a TECAB procedure on the arrested heart (endo-CPB).
Five patients (5/30) had to be converted (mini-thoracotomy + endo-CPB (n=1), robotically enhanced MID-CAB (n=1) and sternotomy + endo-CPB (n=3).
One patient with important atherosclerotic aorto-iliac artery disease died. The morbidity consisted of 1 AMI, 1 duodenal ulcer, 2 SV arrhythmia's, 1 TIA.
In the 25/30 performed TECAB procedures the bypass grafts were Lima -LAD (n=22), Lima-diagonal (n=1) and a sequential graft Lima-diagonal-LAD (n= 2).
Early in-hospital control angiography revealed a distal anastomosis patency rate of 24/25. This one patient with occluded lima underwent a MIDCAB on POD 3.
Eleven patients were treated intentionally with a combination of TECAB and a percutaneous coronary intervention (hybrid therapy).
Conclusion : Totally endoscopic robotically assisted coronary artery bypass surgery (TECAB) can offer to well selected patients a really minimally invasive surgical treatment with op timal comfort, cosmetic result and fast rehabilitation.
However there is an important learning-curve.
Hybrid therapy can possibly offer the best of both worlds to some patients and extend the indications for Tecab surgery.