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Background: Minimally invasive direct coronary artery bypass (MIDCAB) has been revived with new techniques and hybrid procedures for MIDCAB and percutaneous coronary intervention (PCI). We reviewed the midterm results of MIDCAB with a three-dimensional (3D) endoscope in our institution.
Methods: Of the 359 patients who underwent off-pump coronary a...
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Context 1
... 10.5761/atcs.oa.18-00254 the LAD anastomosis position from the sternum and determined the incision position ( Fig. 1). At the time of surgery, after the introduction of general anesthesia, intubation with a double lumen tube was performed, and intraoperative oxygenation was performed with single lung ventilation. The towel was placed under the left shoulder blade and rotated 30 degrees to the right of the bed. The left hand was placed on the operating ...
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Methods:
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Citations
... Advances in endoscopy and robotics have made MIDCAB even less invasive and safer than before 37,38) . Compared to the earlier days when LITAs were harvested using thoracic lifting-type open chest retractors, pain control has improved significantly in MIDCAB thanks to endoscopic and robotic approaches. ...
Hybrid coronary revascularization (HCR) is an emerging approach for multivessel coronary artery disease that combines the excellent long-term outcomes of surgery with the faster recovery and reduced short-term complications of percutaneous coronary intervention. This review addresses the features of HCR, including patient selection and effectiveness.
... Since the images are 2D, it is a disadvantage that requires adaptation and an individual learning curve for hand-eye coordination [16]. Advanced 3D images provided by the 3D endocameras and screens will likely enhance the performance [17,18]. ...
Objectives:
Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease.
Methods:
It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy.
Results:
Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9.
Conclusions:
Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.
... In the meantime, McGinn and Ruel standardized the multivessel minimally invasive surgery CABG procedure through a minithoracotomy with excellent results. 5 In addition, endoscopes with 3-dimensional vision 6 and articulating thoracoscopic instruments have contributed to advance this procedure in some centers without a robotic system. ...
... In our series 40% of the patients underwent HCR. The 30-day mortality was 1.7% (n = 4) that is comparable to the published data of other centers (5,(10)(11)(12). Conversion to sternotomy (without cardiopulmonary bypass) was necessary in one patient (0.4%) that is acceptable and similar to published data (5,10). ...
Introduction
Minimally invasive approach in cardiac surgery has gained popularity. In order to reduce surgical trauma in coronary surgery minimally invasive direct coronary artery bypass (MIDCAB) has already been established. This technique has been introduced for revascularisation of isolated left anterior descending (LAD). It can also be performed for hybrid revascularisation procedure in multi-vessel disease.
Methods
From 2017 to 2021, 234 patients received MIDCAB operation in our heartcenter 73% were male. Most of the patients had two or three vessel disease (74%). The average age of the patients was 66 ± 12 years mean. The left internal mammary artery (LIMA) was anastomosed to the LAD through left minithoracotomy approach. Multi-vessel MIDCAB (MV-MIDCAB) including two anastomoses (T-graft to LIMA with additional saphenous vein graft) was done in 15% ( n = 35).
Results
The average operation time was 2.3 ± 0.8 h mean. The 30-day mortality was 1.7% ( n = 4). The average amount of packed red blood cells (pRBC) that was given intra- and postoperatively was 0.4 ± 0.8 units mean. The mean intensive care unit stay (ICU) was 1 ± 1.2 days. Three patients (1.3%) had wound infection postoperatively. The rate of neurologic complications was 0.4% ( n = 1). Two patients (0.9%) had myocardial infarction and received coronary re-angiography perioperatively including stent implantation of the right coronary artery.
Discussion
The MIDCAB procedure is a safe and less traumatic procedure for selected patients with proximal LAD lesions. It is also an option for hybrid procedure in multi-vessel disease. The ICU stay and application of pRBC’s are low. Our MIDCAB results show a good postoperative clinical outcome. However, follow-up data are necessary to evaluate long-term outcome.
... The high-quality 3D visual feedback from the Da Vinci™ system provides an excellent visual response and indemnification through the visualization of tissue rearrangement and contortion. The administration of robotic technology to CABG also provides a full continuum of advanced technical skills (31)(32)(33)(34)(35)(36)(37)(38)(39)(40). This is due to the surgeon skills and to the lack of tremor movement combined with high-powered and magnified vision of the robot. ...
... This is due to the surgeon skills and to the lack of tremor movement combined with high-powered and magnified vision of the robot. Gain dexterity in using visual clues without perceptive and tactile feedback for the robot-assisted LITA harvest while gaining confidence with carrying out beatingheart off-pump LITA-LAD grafting through a 3-4 cm antero-lateral thoracotomy are crucial steps to technically perform this surgical approach (40). There is a myriad of pathways regarding the learning curve experience for both robotic-assisted MIDCAB and TECAB. ...
... However, as with advancement in technology and research in cardiovascular surgery, minimal invasive techniques have been introduced. Recently the less invasive procedures for ITAs takedown are: small incision in the anterolateral chest and ITAs takedown under direct vision [8], thoracoscopic ITAs take down [9], and robotic-assisted ITAs take down [10]. ...
Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.
... Three-dimensional endoscopy has become more prevalent in numerous surgical specialties, including cardiothoracic surgery, otorhinolaryngology, and cranial. [39][40][41][42] One benefit of 3D endoscopy is depth perception to estimate relative distances, which can only be accomplished in traditional endoscopy by moving the endoscope. 40 Three-dimensional endoscopy differs from traditional endoscopy in the way in which images are obtained, processed, and visualized. ...
... The 2 images are then visualized with the image from the left camera projected into the left eye and the image from the right camera projected into the right eye, usually with 3D glasses or a virtual reality headset. 39 Although stereoscopic encoding is widely used in 3D endoscopy, there are several drawbacks. Because the point of convergence of the 2 endoscopic cameras must match the focus length of both lenses, tissues within the periphery of the image can appear out of focus, which can make intraoperative orientation and navigation challenging. ...
Given the inherent limitations of spinal endoscopic surgery, proper lighting and visualization are of tremendous importance. These limitations include a small field of view, significant potential for disorientation, and small working cannulas. While modern endoscopic surgery has evolved in spite of these shortcomings, further progress in improving and enhancing visualization must be made to improve the safety and efficacy of endoscopic surgery. However, in order to understand potential avenues for improvement, a strong basis in the physical principles behind modern endoscopic surgery is first required. Having established these principles, novel techniques for enhanced visualization can be considered. Most compelling are technologies that leverage the concepts of light transformation, tissue manipulation, and image processing. These broad categories of enhanced visualization are well established in other surgical subspecialties and include techniques such as optical chromoendoscopy, fluorescence imaging, and 3-dimensional endoscopy. These techniques have clear applications to spinal endoscopy and represent important avenues for future research.
... The graft to coronary anastomosis is usually performed through a minithoracotomy under direct vision on the beating heart with local target vessel stabilization and temporary coronary artery occlusion. Table 2, 1,197 cases are reported in the literature (23,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), 87.6% of them were single LIMA to LAD grafts. The LIMA harvesting time averaged 47.5±7.8 ...
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
Proper lighting and visualization have always been critical to safe surgical interventions for the very reason that, in general, one cannot operate if one cannot see. To this end, there has been tremendous innovation over the past century in developing enhanced lighting techniques to aid in visualization and anatomic identification. These enhanced lighting techniques take on special importance in endoscopic surgery given two fundamental departures from traditional, open surgery: (1) the narrowed minimally invasive apertures with which to get light in and light out and (2) the indirect nature of visualization, a result of optical manipulation and digital image transformation.
