Reichenspurner H, Damiano R J, Mack M, Boehm D H, Gulbins H, Detter C, Meiser B, Ellgass R, Reichart B
Department of Cardiac Surgery, University Hospital Munich-Grosshadern, D-81366 Munich, Germany.
J Thorac Cardiovasc Surg. 1999 Jul;118(1):11-6. doi: 10.1016/S0022-5223(99)70134-0.
With the aim of performing a completely endoscopic coronary bypass anastomosis, we have undertaken an experimental and clinical study using robotic instrumentation and voice-controlled camera guidance.
The ZEUS Robotic Surgical System (Computer Motion Inc, Goleta, Calif) consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion) positions the endoscope via voice control.
In a phantom model, vascular grafts were anastomosed to the left anterior descending coronary artery (LAD) of 50 pig hearts with either 2- or 3-dimensional visualization.
In 6 dogs (FBI 20-25 kg) the left internal thoracic artery (LITA) was harvested endoscopically. Then the animals were placed on an endovascular cardiopulmonary bypass system (Port-Access, Heartport, Inc, Redwood City, Calif). Anastomosis of the LITA to the LAD was performed endoscopically with the telemetric ZEUS instruments. Flow rates through the LITA were measured by Doppler analysis.
Two patients were operated on with the ZEUS system. After endoscopic harvesting of the LITA and cardiopulmonary bypass with the Port-Access system, the bypass graft (LITA-LAD) was anastomosed endoscopically with the ZEUS system through three thoracic ports.
In the dry laboratory, the time range required for the robotically assisted coronary anastomosis was 35 to 60 minutes with 2-dimensional visualization and 16 to 32 minutes with 3-dimensional visualization. In the animal experiments, the median time for endoscopic harvesting of the LITA was 86 minutes (range 56-120 minutes) and for the anastomosis, 42 minutes (range 35-105 minutes); flow rates through the LITA ranged between 22 and 45 mL/min. In the clinical cases, preparation times for the LITA were 83 and 110 minutes, respectively, and anastomosis times, 42 and 40 minutes, respectively. Doppler flow rates measured 125 and 85 mL/min, respectively. Both patients had an uneventful follow-up angiogram and postoperative course.
With sophisticated robotic technology, a completely endoscopic anastomosis of the LITA to the LAD is possible, allowing technically precise operations within acceptable time limits.
为了实现完全内镜下冠状动脉搭桥吻合术，我们采用机器人器械和语音控制的摄像头引导进行了一项实验和临床研究。
ZEUS机器人手术系统（计算机运动公司，加利福尼亚州戈利塔）由三个交互式机器人手臂和一个控制单元组成，允许外科医生以缩小模式移动器械臂。第三个手臂（AESOP，计算机运动公司）通过语音控制定位内窥镜。
在一个模拟模型中，使用二维或三维可视化技术，将血管移植物吻合到50个猪心脏的左前降支冠状动脉（LAD）上。
在6只犬（体重20 - 25千克）身上，通过内镜获取左内乳动脉（LITA）。然后将动物置于血管内体外循环系统（Port - Access，Heartport公司，加利福尼亚州红木城）上。使用遥测ZEUS器械通过内镜将LITA吻合到LAD上。通过多普勒分析测量通过LITA的流速。
两名患者使用ZEUS系统进行手术。在内镜获取LITA并使用Port - Access系统进行体外循环后，通过三个胸部端口使用ZEUS系统将搭桥移植物（LITA - LAD）进行内镜下吻合。
在体外实验中，二维可视化下机器人辅助冠状动脉吻合所需的时间范围为35至60分钟，三维可视化下为16至32分钟。在动物实验中，内镜获取LITA的中位时间为86分钟（范围56 - 120分钟），吻合时间为42分钟（范围35 - 105分钟）；通过LITA的流速在22至45毫升/分钟之间。在临床病例中，获取LITA的准备时间分别为83和110分钟，吻合时间分别为42和40分钟。多普勒流速分别测量为125和85毫升/分钟。两名患者的随访血管造影和术后过程均顺利。
借助先进的机器人技术，LITA与LAD的完全内镜下吻合是可行的，能够在可接受的时间限制内进行技术上精确的手术。
