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Ann Thorac Surg 2009;88:523-527. doi:10.1016/j.athoracsur.2009.04.089
© 2009 The Society of Thoracic Surgeons
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Thomas Schachner
Nikolaos Bonaros
Gudrun Feuchtner
Guy Friedrich
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Original Articles: Adult Cardiac

Training Surgeons to Perform Robotically Assisted Totally Endoscopic Coronary Surgery

Thomas Schachner, MDa,*, Nikolaos Bonaros, MDa, Dominik Wiedemann, MDa, Felix Weidinger, MDa, Gudrun Feuchtner, MDa, Guy Friedrich, MDa, Guenther Laufer, MDa, Johannes Bonatti, MDb

a Innsbruck Medical University, Innsbruck, Austria
b Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland

Accepted for publication April 24, 2009.

* Address correspondence to Dr Schachner, Associate Professor of Surgery, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria (Email: thomas.schachner{at}i-med.ac.at).

Background: Robotic totally endoscopic coronary bypass (TECAB) surgery was developed during the past decade, and younger surgeons need to be trained in this new modality. This study assessed the learning curves and independent TECAB performance of 2 junior surgeons undergoing TECAB training.

Methods: Two surgeons in training performed portions of 44 of 239 robotic TECAB operations, including left (LIMA) and right interior mammary artery (RIMA) harvesting, lipectomy, pericardiotomy, and IMA to left anterior descending coronary artery (LAD) anastomotic suturing.

Results: The procedure portions performed faster by the senior surgeon vs trainees were, in minutes (range), lipectomy, 5 (2 to 18) vs 10 (5 to 21; p < 0.001); pericardiotomy, 5 (1 to 21) vs 7 (3 to 16; p = 0.001); RIMA takedown, 35 (25 to 48) vs 49 (40 to 55; p = 0.034); and LIMA to LAD anastomosis, 26 (12 to 100) vs 34 (24 to 67; p = 0.043). After assuming senior roles in the robotic cardiac surgery program, the 2 trained surgeons performed 14 TECABs (LIMA to LAD) without the senior surgeon. Lipectomy took 5 (3 to 8) minutes; pericardiotomy, 5 (2 to 10) minutes; LIMA takedown, 43 (27 to 70) minutes; LIMA to LAD anastomosis, 24 (15 to 60) minutes, cardiopulmonary bypass time, 73 (40 to 126) minutes; and aortic endo-occlusion time, 53 (0 to 83) minutes. No hospital deaths occurred.

Conclusions: TECAB can be well taught with a stepwise training program involving portions of the procedure performed by trainees. With such an approach, independent performance after training can be within adequate time limits and yields seemingly acceptable results.


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Invited Commentary
Jacob Bergsland
Ann. Thorac. Surg. 2009 88: 527-528. [Extract] [Full Text] [PDF]



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J. Bergsland
Invited commentary.
Ann. Thorac. Surg., August 1, 2009; 88(2): 527 - 528.
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