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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2006 April;19(2):111-3
Off-pump robotic-assisted revascularization of the left heart through mini-thoracotomy
Mariani M. A., Codecasa R., D’Alfonso A., Grandjean J. G.
Department of Cardio Thoracic Surgery University Hospital of Pisa, Italy
Aim. Minimally invasive coronary surgery through a small thoracotomy is an estabilished procedure for off-pump revascularization of left anterior descending and the recent advances in robotic technology make closed-chest mammary harvesting possible.
Methods. From February to December 2001, 27 patients have successfully undergone mammary harvesting using the “da Vinci” robotic system (Intuitive SurgicalTM, Mountain View, CA, USA). In two patients “off-pump” robotic-assisted revascularization of left anterior descending and a marginal branch was made with a composite-graft made of both mammary arteries through a left mini-thoracotomy. Both mammaries were harvested using the “da Vinci” robotic system, then a left antero-lateral mini-thoracotomy was performed. The composite graft and the mammary-to-coronary anastomoses were performed off-pump under direct view.
Results. Both patients were discharged, 6 and 8 days after the operation respectively, without postoperative complications. At three months follow-up not clinical evidence of anterior and lateral ischemia was found.
Conclusions. With our technique we keep the advantages of off-pump arterial revascularization with a T-graft of both mammaries, without sternotomy of both LAD and circumflex artery. In patients with diabetes and/or chronic obstructive pulmonary disease this technique prevents sternotomy-related complications. The anastomoses were performed under direct view and with a standard technique, therefore mid- and long-term results are expected to be similar to the open procedure.