Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Circ J. 2012;76(9):2058-65. doi: 10.1253/circj.cj-12-0981. Epub 2012 Aug 11.
Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart. It is a procedure that can be a useful alternative to the classic open procedure performed through sternotomy. After extensive modeling in cadavers, the first clinical case was performed in June 1998 placing a left internal thoracic artery graft (LITA) to the left anterior descending artery completely robotically on the arrested heart. During the early and late 2000s, international groups have adopted this evolving technology, which has included iterations such as beating-heart TECAB, use of bilateral ITA grafting and radial artery grafting, as well as 3- and 4-vessel TECAB. TECAB is combined with percutaneous coronary intervention in hybrid procedures. Despite increasing complexity of endoscopic coronary bypass surgery, conversion rates to open bypass surgery have dropped significantly and operative times have decreased. Published major morbidities and mortality rates in arrested-and beating-heart TECAB have been cumulatively in the 0-2% range and are considered well within the expected range for these highly complex surgical procedures. Long-term survival and freedom from major adverse events also meet the standards of open bypass surgery.
机器人全内窥镜冠状动脉旁路移植术（TECAB）是一种微创内窥镜手术方法，使用达芬奇机器人远程操作系统在停跳或跳动的心脏上进行冠状动脉旁路移植术。它是一种可以替代经典胸骨切开术的有效方法。在对尸体进行广泛建模后，于 1998 年 6 月首次进行了临床病例，在停跳的心脏上完全通过机器人将左内乳动脉移植物（LITA）移植到左前降支。在 2000 年代早期和晚期，国际团队采用了这项不断发展的技术，其中包括心脏跳动的 TECAB、双侧 ITA 移植物和桡动脉移植物的应用，以及 3 支和 4 支 TECAB。TECAB 与杂交手术中的经皮冠状动脉介入治疗相结合。尽管内窥镜冠状动脉旁路手术的复杂性不断增加，但转为开放旁路手术的比例显著下降，手术时间也有所缩短。已公布的停跳和心脏跳动的 TECAB 的主要发病率和死亡率累积在 0-2%之间，被认为处于这些高度复杂手术的预期范围内。长期生存率和无重大不良事件的发生率也符合开放旁路手术的标准。
