In the newest CTSNet Guest Editor Series, “Robotic-Assisted Coronary Artery Bypass Graft Surgery—Techniques and Procedures,” consultant cardiac surgeon Dr. M. M. Yusuf brought together cardiac surgery experts from around the world to contribute procedure videos on various techniques for harvesting the internal mammary artery (IMA), a conduit to performing CABG procedures using robotic systems, and techniques used to expose the heart and perform coronary anastamoses following IMA harvest.
This series features contributor videos from five global cardiothoracic surgeons, which can be found at the bottom of this page as they are released from 5–9 August 2024, concluding with a webinar to be aired live on 9 August 2024.
In this webinar, Dr. Yusuf and five contributors discuss their expertise with robot-assisted CABG and the merits of their techniques for a variety of procedures, as demonstrated in the surgical cases published as part of this Guest Editor Series.
Dear CTSNet Reader,
Coronary artery bypass grafting (CABG) is still considered a gold standard procedure of care for some patients with significant coronary artery disease. Internal thoracic artery (ITA) grafts have been shown to have longer patency rates when compared to saphenous vein grafts when used for the bypass surgery. One of the major contributors to morbidity during and after CABG is sternotomy. Various disadvantages including post operative pain, wound-related complications, increased bleeding from the sternum, slow return to activity, and a visible scar have been attributed to sternotomy.
Various surgical techniques have evolved over the last few decades that allow surgeons to perform CABG using approaches other than sternotomy. The evolution of robotic surgical systems has aided the access to the intrathoracic organs, including ITAs and coronary arteries, allowing for surgery to be performed without cutting open the sternum. Furthermore, techniques have been developed to perform ITA to coronary anastomosis using the same robotic surgical systems with acceptable results.
The techniques to perform robotic-assisted CABG require dedicated learning of the system, the techniques, and the coronary anastomoses for the procedure to be beneficial to patients. Potential benefits include less pain, shorter recovery times, smaller scars, improved cosmesis, and the best-long term patency.
This particular topic was selected for this Guest Editor Series to highlight the tips and pitfalls for ITA harvest and subsequent ITA to coronary anastomosis using robotic surgical systems and techniques to improve understanding and minimize complications during surgery.
This series includes videos from five different surgeons who are experts in the field showcasing various techniques they practice.
Dr. M. M. Yusuf from Apollo Hospitals, Chennai, India, demonstrates the novel double docking technique to harvest bilateral ITAs while the robot is docked on the contralateral side of each ITA harvest. This technique highlights the advantages in terms of easy adaptability, longer ITA length and how this aids in performing total arterial CABG
Dr. Shantanu Pande from Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, showcases the technique of harvesting bilateral ITAs from the same side without the need to redock the robot from the left side, which has its own limitations and benefits.
Dr. Husam Balkhy from University of Chicago Medicine, USA, demonstrates techniques for performing total endoscopic CABG (TECAB) using the Da Vinci Si system and myocardial stabilizer, highlighting the benefits of surgery in terms of no cuts other than robotic port sites.
Dr. Frank Van Praet from the Cardiovascular Center OLV, Aalst, Belgium, demonstrates single ITA harvest and how to perform single vessel CABG without retracting any ribs using only soft tissue spreaders.
Dr. Nitin Rajput from Narayana Health, Bangalore, India, shares his experience and demonstrates the use of a surgical system other than Da Vinci systems, which are most commonly used for robot-assisted cardiac surgeries. He highlights an indigenously developed Indian robotic surgical system—SSI Mantra—to perform ITA harvest. He also demonstrates how a surgeon can adapt to different surgical systems with ease once the basic concepts of robot-assisted surgery are learned and practiced.
It is our hope that this special series positively impacts patients undergoing CABG and highlights the advantages and pitfalls of using robotic surgical systems for robotic-assisted CABG.
Dr. M. M. Yusuf, FRCS
Contributor Videos
1. Total Arterial Revascularization for Multi-Vessel Coronary Artery Disease by M. M. Yusuf
3. Robotic Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting by Frank Van Praet
5. Bilateral Internal Mammary Artery Harvest Using an SSi MANTRA by Nitin Rajput
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