Boyd W D, Kiaii B, Novick R J, Rayman R, Ganapathy S, Dobkowski W B, Jablonsky G, McKenzie F N, Menkis A H
London Health Sciences Centre, University of Western Ontario.
Can J Surg. 2001 Feb;44(1):45-50.
To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA).
A case series.
London Health Sciences Centre, University of Western Ontario, London, Ont.
Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting.
Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant.
Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization.
RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days.
RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.
确定使用谐波手术刀和机器人辅助技术辅助胸腔镜下获取胸廓内动脉（ITA）的疗效。
病例系列。
安大略省伦敦市西安大略大学伦敦健康科学中心。
连续15例需要获取ITA进行冠状动脉旁路移植术的患者。
通过有限切口进行机器人辅助、视频增强冠状动脉旁路移植术（RAVECAB），使用谐波手术刀和语音激活机器人助手。
获取技术的难易程度和持续时间、手术并发症、移植物血流和通畅情况以及术后住院时间。
在所有病例中，RAVECAB均使用谐波手术刀辅助胸腔镜下ITA解剖。无一例转为标准手术方式，也无需因出血进行再次手术。ITA平均获取时间（及标准差）为64.1（22.9）分钟（范围为40至118分钟）。机器人语音指令捕获率大于95%。术中移植物平均血流（及标准差）为33.1（26.8）mL/分钟（范围为14至126 mL/分钟）。术后血管造影显示移植物通畅率为100%。无死亡、围手术期心肌梗死或心律失常发生。术后平均住院时间（及标准差）为3.3（0.8）天。
RAVECAB是一项要求较高的手术，解决了“传统”微创冠状动脉旁路移植术的许多缺点。它能在对ITA操作最少的情况下完成完整的蒂部解剖，并确保有足够的血管桥长度和无张力的冠状动脉吻合。所有吻合均通过5至8厘米的乳房下切口在直视下进行。
