Argenziano Michael, Katz Marc, Bonatti Johannes, Srivastava Sudhir, Murphy Douglas, Poirier Robert, Loulmet Didier, Siwek Leland, Kreaden Usha, Ligon David
Milstein Hospital, Columbia University, New York, New York, USA.
Ann Thorac Surg. 2006 May;81(5):1666-74; discussion 1674-5. doi: 10.1016/j.athoracsur.2005.11.007.
Robotic technology has been proven safe and efficacious in the performance of mitral valve repair and atrial septal defect repair. This report describes a Food and Drug Administration-sanctioned multicenter study of the safety and efficacy of the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) for totally endoscopic coronary artery bypass (TECAB) surgery.
Patients requiring left anterior descending (LAD) coronary artery revascularization were eligible. The procedure was performed with femoro-femoral cardiopulmonary bypass (CPB), endoaortic balloon occlusion, and thoracoscopy. All aspects of the procedure were performed with the robotic system, from internal mammary artery harvest to coronary anastomosis.
Ninety-eight patients requiring single-vessel LAD revascularization were enrolled at 12 centers. Thirteen patients (13%) were excluded intraoperatively (eg, failed femoral cannulation, inadequate working space). In 85 patients (69 men, age 58 +/- 10 years) who underwent TECAB, CPB time was 117 +/- 44 minutes, cross-clamp time was 71 +/- 26 minutes, and hospital length of stay was 5.1 +/- 3.4 days. There were five (6%) conversions to open techniques. There were no deaths or strokes, one early reintervention, and one myocardial infarction (1.5%). Three-month angiography was performed in 76 patients, revealing significant anastomotic stenoses (> 50%) or occlusions in 6 patients. Overall freedom from reintervention or angiographic failure was 91%.
Robotic TECAB was accomplished with no mortality, low morbidity, and angiographic patency and reintervention rates comparable with published data. Although the use of CPB was a limitation of the technique, this experience represents a step toward more advanced procedures, such as multivessel or off-pump TECAB.
机器人技术已被证明在二尖瓣修复和房间隔缺损修复手术中是安全有效的。本报告描述了一项经美国食品药品监督管理局批准的多中心研究，该研究旨在探讨达芬奇系统（直观外科公司，加利福尼亚州山景城）用于全内镜冠状动脉搭桥术（TECAB）的安全性和有效性。
需要对左前降支（LAD）冠状动脉进行血运重建的患者符合入选标准。该手术采用股-股体外循环（CPB）、主动脉内球囊阻断和胸腔镜技术进行。手术的各个环节均通过机器人系统完成，从获取乳内动脉到冠状动脉吻合。
12个中心共纳入了98例需要对单支LAD进行血运重建的患者。13例患者（13%）在术中被排除（如股动静脉插管失败、工作空间不足）。85例患者（69例男性，年龄58±10岁）接受了TECAB手术，CPB时间为117±44分钟，主动脉阻断时间为71±26分钟，住院时间为5.1±3.4天。有5例（6%）转为开放手术。无死亡或卒中病例，1例早期再次干预，1例心肌梗死（1.5%）。76例患者进行了术后3个月的血管造影，发现6例患者存在明显的吻合口狭窄（>50%）或闭塞。总体免于再次干预或血管造影失败的比例为91%。
机器人TECAB手术无死亡病例，发病率低，血管造影通畅率和再次干预率与已发表数据相当。虽然使用CPB是该技术的一个局限性，但这一经验代表了向更先进手术（如多支血管或非体外循环TECAB）迈出的一步。
