Wehman Brody, Lehr Eric J, Lahiji Kian, Lee Jeffry D, Kon Zachary N, Jeudy Jean, Griffith Bartley P, Bonatti Johannes
Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA
Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, WA, USA.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):572-6. doi: 10.1093/icvts/ivu226. Epub 2014 Jul 6.
The influence of patient thoracic anatomy on operative times in robotic total endoscopic coronary artery bypass (TECAB) has not been well described. The aim of this study was to determine whether patient anatomy correlates with intraoperative time required to complete various procedural steps and overall operative time in TECAB.
Preoperative multislice computed tomographic scans of the chest from 107 consecutive patients who underwent single-vessel TECAB were reviewed to measure a series of thoracic dimensions and relations. Measurements were correlated with time to complete various intraoperative procedural tasks as well as overall operative time.
There was a significant correlation between left internal mammary artery (LIMA) harvest time and depth of subcutaneous tissue at the level of the nipple (r = 0.24, P = 0.018). Pericardial fat pad thickness was associated with longer resection times (r = 0.266, P = 0.008). LIMA to left anterior descending artery anastomotic time was inversely correlated with the distance from the left heart border to the chest wall (r = -0.241, P = 0.016). Total operative time was also inversely correlated with this distance (r = -0.275, P = 0.005).
Anatomical measurements made on preoperative computed tomography in patients undergoing robotic TECAB can predict time requirements for various procedural steps. A shorter distance between the chest wall and the heart predicts longer anastomotic and total operative times. This information could assist the TECAB surgeon with surgical planning and help guide the TECAB trainee in patient selection.
患者胸廓解剖结构对机器人全内镜冠状动脉搭桥术（TECAB）手术时间的影响尚未得到充分描述。本研究的目的是确定患者的解剖结构是否与TECAB中完成各个手术步骤所需的术中时间以及总手术时间相关。
回顾了107例连续接受单支血管TECAB患者的术前胸部多层计算机断层扫描，以测量一系列胸廓尺寸和关系。测量结果与完成各种术中手术任务的时间以及总手术时间相关联。
左乳内动脉（LIMA）获取时间与乳头水平皮下组织深度之间存在显著相关性（r = 0.24，P = 0.018）。心包脂肪垫厚度与更长的切除时间相关（r = 0.266，P = 0.008）。LIMA至左前降支动脉的吻合时间与左心缘至胸壁的距离呈负相关（r = -0.241，P = 0.016）。总手术时间也与该距离呈负相关（r = -0.275，P = 0.005）。
接受机器人TECAB手术患者的术前计算机断层扫描所做的解剖测量可以预测各个手术步骤的时间需求。胸壁与心脏之间的距离越短，吻合时间和总手术时间越长。这些信息可以帮助TECAB外科医生进行手术规划，并帮助指导TECAB培训学员进行患者选择。
