Ann Thorac Surg 2000;70:2033
© 2000 The Society of Thoracic Surgeons
Invited commentary
Randall K. Wolf, MDa
a Division of Cardiothoracic Surgery, The Ohio State University Medical Center, N 816 Doan Hall, Columbus, OH 43210, USA
e-mail: wolf-4{at}medctr.osu.edu
For several years total endoscopic beating heart coronary artery bypass grafting has been a dream, then challenge, then goal for some minimally invasive cardiac surgeons. Endoscopic beating heart left internal thoracic artery (LITA) to left anterior descending (LAD) coronary artery bypass could provide a durable, truly minimally invasive (not just minimal access) bypass procedure that would likely be superior in the long term to current interventional approaches to the diseased LAD. The work of Falk and associates is important for three main reasons. First, their study demonstrates a totally endoscopic technique for performing the entire LITA to LAD procedure on a beating heart in animals by using enabling computer technology. This is an important step that must be taken on the path to defining a clinically reproducible total endoscopic technique. Secondly, this technique is the sentinel event that heralds enabling virtual reality technology in the cardiac operating suite. The surgeon visualizes the heart not directly, but through a three-dimensional video screen, bringing the cardiac surgeon into the 21st century. Lastly, although this technology holds great promise, there are still major technical hurdles. Some of these technical challenges are identified in the current study. It is therefore appropriate and fitting to place a word of caution against widespread use of robotics in heart surgery without further careful clinical studies. The formation of a users’ group that would meet periodically and function independently and in parallel with the robotic medical device industry might help ensure that cardiac surgeons progress in an orderly and sequential fashion in evaluating and utilizing this technology. We should be acutely aware of the challenges and risks to our patients if this technology is not carefully controlled in our specialty. Although computer-assisted technology may help shorten the learning curve for cardiac surgeons wishing to acquire endoscopic experience, it could also open the door for incompletely endoscopically trained cardiac surgeons who might use techniques that are not yet ready for "prime time." As cardiac surgeons we must make it a priority to foster this technology carefully. The concerns of the generations of surgeons trained in open techniques should not be underestimated. They are valid and need to be addressed in a nonbiased manner. We should continue to be optimistic and excited about the future of computer-assisted technology in cardiac operations, as long as our specialty can ensure its careful evolution and proper clinical use. Then surely our patients will benefit.
Related Article
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Endoscopic computer-enhanced beating heart coronary artery bypass grafting
- Volkmar Falk, James I. Fann, Jürg Grünenfelder, David Daunt, and Thomas A. Burdon
Ann. Thorac. Surg. 2000 70: 2029-2033.
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