Gao Chang-Qing, Yang Ming, Wang Gang, Wang Jia-Li, Li Li-Xia, Zhao Yue, Xiao Cang-Song, Wu Yang, Zhou Qi
Department of Cardiovascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
Zhonghua Wai Ke Za Zhi. 2007 Oct 15;45(20):1414-6.
To summary the first 14 cases undergoing internal mammary artery (IMA) harvest using da Vinci S system and minimally invasive direct coronary artery bypass grafting (MIDCAB) on beating heart.
The average age of patients was (60.4 +/- 10.1) years old. One case was female and 13 male. All the patients had a history of angina. The coronary angiography showed severe stenosis of anterior descending branch in all patients, of which 2 cases had diagonal and circumflex branch stenosis. Four case had myocardial infraction history. All the patients had good lung function and had no medical history of pleurisy. Without sternotomy, the camera cannula was placed in the left, 3 cm lateral to nipple in the 4th intercostal space (ICS). Da Vinci instrument arms were inserted through two 1 cm trocar incisions. The right instrument generally was positioned 4 to 6 cm cephalad to camera cannula in the 2nd or 3rd ICS. The left instrument arm was positioned 4 to 6 cm caudal to the camera cannula in the 5th or 6th ICS. Arm trocar sites were maintained 6 cm apart at chest entry. The internal mammary artery was harvested in routine methods. Thirteen cases underwent left internal mammary artery harvest, one case underwent right internal mammary artery harvest, one case underwent double internal mammary harvest. MIDCAB was performed on beating heart in 14 cases and 1 case accepted the totally endoscopic coronary artery bypass (TECAB).
All cases were accomplished successfully without complications. The average time of ICU was 20 hours. Robotic surgery had less draining than the conventional coronary bypass.
Totally robotic internal mammary artery harvest and beating heart coronary artery bypass is less invasive, more precise, safe and efficient.
总结首例14例使用达芬奇S系统进行乳内动脉（IMA）采集及在心脏跳动下进行微创直接冠状动脉旁路移植术（MIDCAB）的病例。
患者平均年龄为（60.4±10.1）岁。1例为女性，13例为男性。所有患者均有心绞痛病史。冠状动脉造影显示所有患者前降支严重狭窄，其中2例有对角支和回旋支狭窄。4例有心肌梗死病史。所有患者肺功能良好，无胸膜炎病史。不进行胸骨切开术，将摄像套管置于左侧第4肋间间隙（ICS）乳头外侧3 cm处。通过两个1 cm的套管针切口插入达芬奇器械臂。右侧器械通常位于摄像套管头侧4至6 cm处的第2或第3肋间间隙。左侧器械臂位于摄像套管尾侧4至6 cm处的第5或第6肋间间隙。手臂套管针部位在胸部入口处保持6 cm的间距。采用常规方法采集乳内动脉。13例行左乳内动脉采集，1例行右乳内动脉采集，1例行双侧乳内动脉采集。14例在心脏跳动下进行MIDCAB，1例接受完全内镜冠状动脉旁路移植术（TECAB）。
所有病例均成功完成，无并发症。重症监护病房（ICU）平均时间为20小时。机器人手术的引流比传统冠状动脉旁路移植术少。
完全机器人辅助乳内动脉采集及心脏跳动下冠状动脉旁路移植术创伤小、更精确、安全且高效。
