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Ann Thorac Surg 2002;73:1180-1184
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Endoscopic internal thoracic artery dissection leads to significant reduction of pain after minimally invasive direct coronary artery bypass graft surgery

Jan Bucerius, MD*a, Sebastian Metz, MDa, Thomas Walther, MD, PhDa, Volkmar Falk, MD, PhDa, Nicolas Doll, MDa, Frank Noack, MDa, David Holzhey, MDa, Anno Diegeler, MD, PhDa, Friedrich W. Mohr, MD, PhDa

a Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany

Accepted for publication November 15, 2001.

* Address reprint requests to Dr Bucerius, Department of Cardiac Surgery, Heartcenter, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
e-mail: bucerj{at}medizin.uni-leipzig.de

Background. The aim of this study was to evaluate postoperative pain levels after endoscopic versus conventional internal thoracic artery (ITA) dissection for minimally invasive direct coronary artery bypass graft surgery (MIDCABG) surgery. Results were compared with pain levels associated with conventional cardiac bypass operations through a median sternotomy.

Methods. Of 190 patients included in this prospective study, 24 patients had endoscopic ITA takedown (MIDCABG-endo) using the da Vinci telemanipulator followed by a manual coronary anastomosis through a left minithoracotomy. A conventional MIDCABG operation (MIDCABG-conv) was performed in 73 patients with ITA preparation under direct vision. Postoperative pain levels after conventional CABG through a median sternotomy (CABG-conv, n = 93) served as controls. A standarized questionnaire including visual analog scale (VAS) was used for prospective pain assessment from POD 1 to 7.

Results. Pain levels (VAS) declined in all groups from POD 1 to 7. Overall pain levels were significantly lower in the MIDCABG-endo group as compared with MIDCABG-conv and CABG-conv groups, respectively (p < 0.001, general linear model). There was no significant difference between the MIDCABG-conv and CABG-conv (p = not significant, general linear model) groups. Furthermore, patients after MIDCABG-endo required fewer nonsteroidal anti-inflammatory drugs and opioid medications, postoperatively.

Conclusions. An endoscopic ITA takedown in MIDCABG surgery leads to significantly reduced postoperative pain levels possibly because of less rib retraction.


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