Coronary Connector Facilitated Total Endoscopic Coronary Artery Bypass: An Ex Vivo Feasibility Study.

Monica Gianoli, Anne Roos de Jong, Harmen Matthijs Wassink, Paul F Gründeman, Bob Kiaii, Husam H Balkhy, Willem J L Suyker
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Abstract

Objective: Totally endoscopic coronary artery bypass (TECAB) procedures pose significant challenges, motivating the development of Octocon, an automated endoscopic connector designed for coronary anastomoses in off-pump and endoscopic settings. This feasibility study aimed to assess Octocon's functionality and maneuverability in closed-chest conditions during robot-assisted TECAB simulations.

Methods: The Octocon deployment comprises a 3-step procedure. Initially, delicate self-aligning microstapling technology is used to attach connector halves to individual blood vessels. Subsequently, the connector halves are joined to accomplish the anastomosis process. TECAB conditions were simulated using a dedicated box housing ex vivo porcine hearts. The study, conducted by 3 experienced surgeons, investigated the feasibility and standardization potential of a robot-assisted procedure employing Octocon. It evaluated maneuverability in closed-chest conditions and assessed the effectiveness of grafting internal mammary artery segments to different heart regions using single graft, jump graft, and Y-graft constructions.

Results: The robot-assisted procedure, using 4 standard instruments, successfully completed all 3 steps in 18 anastomotic procedures. In 96% of cases, the procedural steps were accomplished on the first attempt. The feasibility of constructing jump graft and Y-graft geometries on both anterior and posterior heart walls was demonstrated. Furthermore, experiences affirmed the device's endoscopic user-friendliness, ease of teachability, reproducibility, and potential to achieve expedient, leak-free anastomoses.

Conclusions: This ex vivo study confirmed Octocon's potential suitability and functionality for TECAB. The device can create diverse grafting strategies and achieve wide-open vascular connections on various heart regions, highlighting its potential in advancing minimally invasive, robot-assisted coronary procedures. These promising results justify further exploration for integration into clinical practice.

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冠状动脉连接器辅助全内镜冠状动脉搭桥术:一项体内外可行性研究。
目的:全内镜冠状动脉搭桥术(TECAB)带来了巨大的挑战,促使 Octocon 的开发,Octocon 是一种自动内镜连接器,设计用于非泵和内镜环境下的冠状动脉吻合。这项可行性研究旨在评估 Octocon 在机器人辅助 TECAB 模拟中闭合胸腔条件下的功能性和可操作性:Octocon 部署包括 3 个步骤。方法:Octocon 的部署包括 3 个步骤。首先,使用精密的自对准微缝技术将连接器的两半连接到单个血管上。随后,连接两半连接器,完成吻合过程。TECAB 条件是使用一个容纳体外猪心的专用箱进行模拟的。这项研究由 3 位经验丰富的外科医生进行,调查了采用 Octocon 的机器人辅助手术的可行性和标准化潜力。该研究评估了闭胸条件下的可操作性,并评估了使用单一移植、跳跃移植和 Y 型移植结构将乳内动脉段移植到不同心脏区域的有效性:结果:机器人辅助手术使用 4 种标准器械,成功完成了 18 例吻合手术的所有 3 个步骤。96%的病例在第一次尝试时就完成了手术步骤。在心脏前壁和后壁上构建跳跃移植物和 Y 形移植物的可行性得到了证实。此外,经验还证实了该装置的内窥镜用户友好性、易学性、可重复性以及实现快速无漏吻合的潜力:这项体内外研究证实了 Octocon 对 TECAB 的潜在适用性和功能性。该设备可以创建多种移植策略,并在不同心脏区域实现开放式血管连接,突出了其在推进微创、机器人辅助冠状动脉手术方面的潜力。这些令人鼓舞的结果证明,有理由进一步探索将其融入临床实践的可能性。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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