Experiences in robotically enhanced IMA-preparation as initial step towards totally endoscopic coronary artery bypass grafting

Aim: To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA).

Method: Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO₂ insufflation and single lung ventilation using electrocautery.

Results: In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7±1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7±21.1 and 99.2±8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9±13.1 s, clip applier 72.8±28.4 s).

Conclusion: Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.