Takata Munehisa, Watanabe Go, Ushijima Teruaki, Ishikawa Norihiko
Division of Cardiac Surgery, Tokyo Medical University, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2009 Nov;9(5):891-2. doi: 10.1510/icvts.2009.212282. Epub 2009 Aug 31.
We have performed 12 cases of robotically assisted coronary artery bypass grafting (CABG) to accomplish less invasive revascularization. In this report, we describe a new method of robotically assisted internal thoracic artery (ITA) harvesting via subxiphoid approach, using the da Vinci surgical system. A 22-year-old man with three-vessel coronary artery disease due to Kawasaki disease was referred to our institution for coronary artery revascularization. A small subxiphoid incision was made, and the xiphoid process at the lower end of the sternum was excised. A U-shaped hook was inserted into the retrosternal space, and the lower sternum was lifted. A 30 degrees angle-up camera was inserted under the U-shaped hook, bilateral ITAs were harvested in a totally skeletonized fashion endoscopically. The required time for right ITA harvesting was 50 min, and that for the left was 20 min. After bilateral ITAs were harvested, composite grafts were made, and then the distal anastomoses were made. The patient was discharged six days after the operation. We performed a new robotically assisted bilateral ITA harvesting technique via sub-xiphoid safely and with excellent results. This method might be an evolutionary step of minimally invasive direct coronary artery bypass (MIDCAB) using the da Vinci surgical system.
我们已进行了12例机器人辅助冠状动脉旁路移植术（CABG）以实现微创血运重建。在本报告中，我们描述了一种使用达芬奇手术系统通过剑突下入路机器人辅助获取胸廓内动脉（ITA）的新方法。一名因川崎病患有三支血管冠状动脉疾病的22岁男性被转诊至我院进行冠状动脉血运重建。做了一个小的剑突下切口，切除胸骨下端的剑突。将一个U形钩插入胸骨后间隙，抬起胸骨下端。在U形钩下方插入一个30度向上的摄像头，以内镜完全骨骼化的方式获取双侧ITA。获取右侧ITA所需时间为50分钟，左侧为20分钟。获取双侧ITA后，制作复合移植物，然后进行远端吻合。患者术后六天出院。我们通过剑突下入路安全地进行了一种新的机器人辅助双侧ITA获取技术，效果极佳。该方法可能是使用达芬奇手术系统的微创直接冠状动脉旁路移植术（MIDCAB）的一个演进步骤。
