Kiaii B, Boyd W D, Rayman R, Dobkowski W B, Ganapathy S, Jablonsky G, Novick R J
London Health Sciences Centre, London, Ontario, Canada.
Heart Surg Forum. 2000;3(3):194-7.
Successful endoscopic harvesting of arterial conduits is critical to the performance of totally endoscopic bypass grafting. Recent success with computer-enhanced robotic systems in the performance of endoscopic single vessel coronary artery bypass (ENDOCAB) has paved the way for developing techniques for multivessel ENDOCAB. The Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) has previously demonstrated versatility and efficacy in manual endoscopic internal thoracic artery (ITA) harvesting. This study was undertaken to determine the feasibility of adapting this technology to a robotic telemanipulation system and its safety and efficacy in telerobotic ITA harvesting.
The Harmonic Scalpel was adapted to the ZEUS robotic surgical system (Computer Motion, Goleta, CA) and used to harvest the ITA in 19 patients undergoing multivessel off-pump coronary artery bypass (OPCAB) surgery. With the left lung collapsed, the ITA was harvested in all patients with CO2 insufflation through three 5 mm ports in the left chest. Postoperative angiography and transthoracic Doppler studies were performed in all patients.
There were no ITA injuries and patients tolerated insufflation without hemodynamic compromise. Side branches were controlled easily without bleeding. Average ITA harvest time was 65 +/- 21 minutes. All vessels were patent after harvesting and demonstrated no angiographic evidence of injury.
This paper demonstrates a technique by which the Harmonic Scalpel can be readily adapted to the ZEUS robotic telemanipulation system. Using this system, ITA's can be safely harvested totally endoscopically within a reasonable time frame for patients undergoing ENDOCAB.
成功地通过内镜获取动脉血管对于完全内镜下旁路移植术的实施至关重要。计算机增强型机器人系统在实施内镜下单支冠状动脉旁路移植术（ENDOCAB）方面最近取得的成功，为开发多支血管ENDOCAB技术铺平了道路。谐波手术刀（爱惜康内镜外科公司，俄亥俄州辛辛那提）先前已证明在手动内镜下获取胸廓内动脉（ITA）时具有多功能性和有效性。本研究旨在确定将该技术应用于机器人远程操作系统的可行性及其在远程机器人ITA获取中的安全性和有效性。
将谐波手术刀适配于ZEUS机器人手术系统（计算机运动公司，加利福尼亚州戈利塔），并用于为19例接受多支血管非体外循环冠状动脉旁路移植术（OPCAB）的患者获取ITA。在左肺萎陷的情况下，通过左胸的三个5毫米端口对所有患者进行二氧化碳充气后获取ITA。所有患者均进行了术后血管造影和经胸多普勒研究。
未发生ITA损伤，患者对充气耐受良好，血流动力学无明显改变。侧支血管易于控制，无出血。ITA平均获取时间为65±21分钟。所有血管在获取后均保持通畅，血管造影未显示损伤迹象。
本文展示了一种可将谐波手术刀轻松适配于ZEUS机器人远程操作系统的技术。使用该系统，对于接受ENDOCAB的患者，可在合理的时间范围内安全地完全通过内镜获取ITA。
