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Bob Kiaii
R. Scott McClure
Reiza Rayman
Richard J. Novick
W. Douglas Boyd
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Ann Thorac Surg 2006;82:624-628
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Prospective Angiographic Comparison of Direct, Endoscopic, and Telesurgical Approaches to Harvesting the Internal Thoracic Artery

Bob Kiaii, MDa,*, R. Scott McClure, MDa, Larry Stitt, MSb, Reiza Rayman, MDa, Wojciech B. Dobkowski, MDc, George Jablonsky, MDd, Richard J. Novick, MDa, W. Douglas Boyd, MDe

a Department of Surgery, London Health Science Center, The University of Western Ontario, London, Ontario, Canada
b Department of Epidemiology and Biostatistics, London Health Science Center, The University of Western Ontario, London, Ontario, Canada
c Department of Anesthesia and Perioperative Care, London Health Science Center, The University of Western Ontario, London, Ontario, Canada
d Department of Medicine, London Health Science Center, The University of Western Ontario, London, Ontario, Canada
e Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, Florida

Accepted for publication March 7, 2006.

* Address correspondence to Dr Kiaii, London Health Science Center, University Campus, 339 Windermere Road, London, Ontario, Canada N6A-5A5 (Email: bob.kiaii{at}lhsc.on.ca).

BACKGROUND: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques.

METHODS: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency.

RESULTS: Average left internal thoracic artery harvest times were 23 ± 2.5, 63.3 ± 20.3, and 66.1 ± 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 ± 11.9, 33.7 ± 19.3, and 36.9 ± 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall).

CONCLUSIONS: The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.




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