Stephenson E R, Sankholkar S, Ducko C T, Damiano R J
Department of Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, Hershey 17033, USA.
Ann Thorac Surg. 1998 Sep;66(3):1064-7. doi: 10.1016/s0003-4975(98)00656-0.
As minimally invasive approaches to cardiac surgery have expanded, a significant number of limitations have become apparent, particularly the lack of adequate precision with standard endoscopic instruments. We hypothesized that the use of robotics would eliminate some of these limitations.
Twenty-five coronary anastomoses on an isolated porcine heart, using an arterial conduit to the left anterior descending artery, were performed endoscopically with a microsurgical robotic system. Sophisticated robotic engineering was used to control modified endoscopic instruments under direct surgeon control. Computer tremor elimination and motion scaling allowed for precise maneuvering. An arteriotomy was placed in the left anterior descending artery, and an arterial conduit was positioned for anastomosis. The camera and port sites were placed 90 degrees from the long axis of the arteriotomy. A 7-0 Prolene (Ethicon, Somerville, NJ) suture was used to perform the anastomosis in a continuous fashion, begun at the 12 o'clock position and continued counterclockwise. After completion of half of the anastomosis, the conduits were pulled down and the final sutures were placed. The sutures were tied intracorporeally and the procedure was completed.
The 25 conduits were successfully completed and showed good probe patency. Average time for completion of the anastomosis was 31.7 +/- 2.0 minutes. Appropriate port placement and orientation, and stabilization of the conduits were critical. The lack of tremor and motion scaling allowed for the precise movements needed to complete an endoscopic microvascular anastomosis.
Coronary artery anastomoses are technically feasible with use of robotic instrumentation. This technology may enable the development of a truly endoscopic approach to bypass surgery.
随着心脏手术微创方法的不断扩展，大量局限性日益明显，尤其是标准内镜器械缺乏足够的精准度。我们推测使用机器人技术将消除其中一些局限性。
使用显微外科机器人系统，通过动脉导管连接至左前降支动脉，在离体猪心脏上进行了25例冠状动脉吻合术。采用先进的机器人工程技术，在外科医生直接控制下操控改良的内镜器械。计算机震颤消除和运动缩放功能实现了精确操作。在左前降支动脉上做动脉切口，并放置动脉导管进行吻合。摄像头和端口位置与动脉切口的长轴呈90度角。使用7-0普理灵缝线（Ethicon公司，新泽西州萨默维尔）以连续方式进行吻合，从12点位置开始，逆时针方向进行。吻合完成一半后，将导管下拉并放置最后的缝线。缝线在体内打结，手术完成。
成功完成了25例导管吻合，显示出良好的探查通畅性。吻合完成的平均时间为31.7±2.0分钟。合适的端口放置和方向以及导管的稳定至关重要。震颤消除和运动缩放功能使得完成内镜下微血管吻合所需的精确动作成为可能。
使用机器人器械进行冠状动脉吻合在技术上是可行的。这项技术可能促使真正的内镜旁路手术得以发展。
