Bolotin Gil, Scott Walter W, Austin Trevor C, Charland Patrick J, Kypson Alan P, Nifong L Wiley, Salleng Kenneth, Chitwood W Randolph
Division of Cardiothoracic Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
Ann Thorac Surg. 2004 Apr;77(4):1262-5. doi: 10.1016/j.athoracsur.2003.09.074.
The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA).
Nine dogs underwent bilateral robotic internal thoracic artery harvesting through three ports placed in the left chest. One internal thoracic artery was harvested as a pedicle in each dog, and the other was skeletonized. Internal thoracic artery blood flow was measured in each graft, and comparative endothelial histologic studies were performed. Data are mean +/- the standard error of the mean.
All 18 internal thoracic arteries were harvested successfully. Skeletonized internal thoracic artery harvests required more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvests (39.0 minutes +/- 1.4; p < 0.05). Internal thoracic artery flows during the final intervals were similar (skeletonized = 30.0 mL/min +/- 2.4 vs pedicle = 31.5 mL/min +/- 1.8; p = 0.9). Free internal thoracic artery bleeding flow was similar in both groups (skeletonized = 162.0 mL/min +/- 3.0 vs pedicle = 189.0 mL/min +/- 2.4; p = 0.4). Histologically, both groups were similar with minimal endothelial damage.
Robotically skeletonized harvesting is safe, but it requires more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvesting. Despite muted tactile feedback with robotics, neither technique was associated with histologic or functional damage. These encouraging results may represent an advantage for complete arterial revascularization in robotic coronary bypass patients.
胸廓内动脉骨骼化的优点包括早期高血流量、更长的血管桥以及比带蒂胸廓内动脉移植物出血更少。完全内镜下动脉血运重建需要更长的血管桥。因此，本研究旨在确定使用达芬奇机器人系统（直观外科公司，加利福尼亚州桑尼维尔）进行胸廓内动脉骨骼化的可行性和安全性。
9只犬通过置于左胸的3个端口接受双侧机器人胸廓内动脉采集。每只犬一侧胸廓内动脉作为带蒂采集，另一侧进行骨骼化处理。测量每个移植物的胸廓内动脉血流量，并进行内皮组织学比较研究。数据为平均值±平均标准误差。
18条胸廓内动脉全部成功采集。胸廓内动脉骨骼化采集所需时间（48.0分钟±1.8）比带蒂胸廓内动脉采集（39.0分钟±1.4；p<0.05）更长。最终时间段内胸廓内动脉血流量相似（骨骼化=30.0毫升/分钟±2.4，带蒂=31.5毫升/分钟±1.8；p=0.9）。两组胸廓内动脉游离出血流量相似（骨骼化=162.0毫升/分钟±3.0，带蒂=189.0毫升/分钟±2.4；p=0.4）。组织学上，两组相似，内皮损伤最小。
机器人骨骼化采集是安全的，但比带蒂胸廓内动脉采集需要更多时间（48.0分钟±1.8）。尽管机器人触觉反馈减弱，但两种技术均未导致组织学或功能损伤。这些令人鼓舞的结果可能代表了机器人冠状动脉搭桥患者完全动脉血运重建的一个优势。
