Kappert U, Cichon R, Gulielmos V, Schneider J, Schramm I, Nicolai J, Tugtekin S M, Schueler S
Department of Cardiac Surgery, Department of Anesthesiology; Cardiovascular Institute, University of Dresden, Germany.
Heart Surg Forum. 2000;3(4):319-21.
The introduction of robotic-enhanced endoscopic instrumentation systems allows the surgeon to perform arterial revascularization for multivessel coronary artery disease without sternotomy.
From April 1999, 27 patients (6 female, 21 male, median age 63 +/- 8.2 years) suffering from multivessel coronary artery disease were treated surgically using arterial revascularization by means of bilateral internal mammary artery (BIMA) grafting. Both arteries were harvested totally endoscopically using the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA). These vessels were anastomosed using the "Dresden Technique" via a left minithoracotomy in the second intercostal space.
All patients survived the operation. The mean duration of surgery was 240 +/- 79.4 minutes. Bilateral internal mammary artery harvesting time was 88.5 +/- 15.9 minutes, and cross-clamp time was 38 +/- 10.9 minutes. An average of 2.07 anastomoses were performed per operation. Postoperatively, the patients remained in ICU for 20 +/- 2.4 hours. One patient needed reexploration due to bleeding.
Bilateral internal mammary artery harvesting can be achieved safely with the use of wrist-enhanced instrumentation. The robotic surgical system introduces into surgical practice a new type of treatment of coronary artery disease, helping to perform arterial revascularization with a distinctly reduced surgical trauma.
机器人辅助内镜器械系统的引入使外科医生能够在不进行胸骨切开术的情况下对多支冠状动脉疾病进行动脉血运重建。
自1999年4月起，对27例（6例女性，21例男性，中位年龄63±8.2岁）多支冠状动脉疾病患者采用双侧乳内动脉（BIMA）移植术进行动脉血运重建手术治疗。使用达芬奇机器人手术系统（直观外科公司，加利福尼亚州山景城）完全通过内镜获取双侧乳内动脉。这些血管通过第二肋间间隙的左胸小切口，采用“德累斯顿技术”进行吻合。
所有患者均手术存活。平均手术时间为240±79.4分钟。双侧乳内动脉获取时间为88.5±15.9分钟，阻断时间为38±10.9分钟。平均每例手术进行2.07次吻合。术后，患者在重症监护病房（ICU）停留20±2.4小时。1例患者因出血需要再次探查。
使用腕部增强器械能够安全地获取双侧乳内动脉。机器人手术系统为冠状动脉疾病的外科治疗引入了一种新型治疗方法，有助于在显著减少手术创伤的情况下进行动脉血运重建。
