Gianoli Monica, de Jong Anne Roos, Wassink Harmen Matthijs, Gründeman Paul F, Kiaii Bob, Balkhy Husam H, Suyker Willem J L
Cardiothoracic Surgery, UMC Utrecht, The Netherlands.
Medical Technology & Clinical Physics, UMC Utrecht, The Netherlands.
Innovations (Phila). 2024 Nov-Dec;19(6):640-647. doi: 10.1177/15569845241288540. Epub 2024 Oct 29.
Totally endoscopic coronary artery bypass (TECAB) procedures pose significant challenges, motivating the development of Octocon, an automated endoscopic connector designed for coronary anastomoses in off-pump and endoscopic settings. This feasibility study aimed to assess Octocon's functionality and maneuverability in closed-chest conditions during robot-assisted TECAB simulations.
The Octocon deployment comprises a 3-step procedure. Initially, delicate self-aligning microstapling technology is used to attach connector halves to individual blood vessels. Subsequently, the connector halves are joined to accomplish the anastomosis process. TECAB conditions were simulated using a dedicated box housing ex vivo porcine hearts. The study, conducted by 3 experienced surgeons, investigated the feasibility and standardization potential of a robot-assisted procedure employing Octocon. It evaluated maneuverability in closed-chest conditions and assessed the effectiveness of grafting internal mammary artery segments to different heart regions using single graft, jump graft, and Y-graft constructions.
The robot-assisted procedure, using 4 standard instruments, successfully completed all 3 steps in 18 anastomotic procedures. In 96% of cases, the procedural steps were accomplished on the first attempt. The feasibility of constructing jump graft and Y-graft geometries on both anterior and posterior heart walls was demonstrated. Furthermore, experiences affirmed the device's endoscopic user-friendliness, ease of teachability, reproducibility, and potential to achieve expedient, leak-free anastomoses.
This ex vivo study confirmed Octocon's potential suitability and functionality for TECAB. The device can create diverse grafting strategies and achieve wide-open vascular connections on various heart regions, highlighting its potential in advancing minimally invasive, robot-assisted coronary procedures. These promising results justify further exploration for integration into clinical practice.
完全内镜下冠状动脉搭桥术（TECAB）面临重大挑战，这促使了Octocon的研发，Octocon是一种专为非体外循环和内镜手术环境下的冠状动脉吻合设计的自动内镜连接器。本可行性研究旨在评估Octocon在机器人辅助TECAB模拟的闭胸条件下的功能和可操作性。
Octocon的部署包括三个步骤。首先，使用精细的自动对准微型缝合技术将连接器的两半分别连接到各自的血管上。随后，将连接器的两半连接起来完成吻合过程。使用一个装有离体猪心脏的专用盒子模拟TECAB手术条件。该研究由3位经验丰富的外科医生进行，调查了采用Octocon的机器人辅助手术的可行性和标准化潜力。评估了其在闭胸条件下的可操作性，并使用单支移植物、跳跃移植物和Y形移植物结构评估了将乳内动脉段移植到不同心脏区域的有效性。
使用4种标准器械的机器人辅助手术在18例吻合手术中成功完成了所有三个步骤。在96%的病例中，手术步骤在首次尝试时就完成了。证明了在前壁和后壁心脏上构建跳跃移植物和Y形移植物几何形状的可行性。此外，经验证实了该设备在内镜下的用户友好性、易于教学性、可重复性以及实现快速、无渗漏吻合的潜力。
这项离体研究证实了Octocon在TECAB中的潜在适用性和功能。该设备可以创造多种移植策略，并在不同心脏区域实现广泛开放的血管连接，突出了其在推进微创、机器人辅助冠状动脉手术方面的潜力。这些有前景的结果证明有必要进一步探索将其整合到临床实践中。
