Total endoscopic CABG using robotics on beating heart

Background: The implementation of a total endoscopic coronary surgery on the beating heart with the aid of the Da Vinci surgical system ( Intuitive, Sunnyvale, CA) requires a stepwise learning process. After cadaveric training and clinical start of the program in November 2002, we gained experience with arrested heart procedures starting in May 2003. In November 2003, we moved to beating heart surgery. Methods: From November 2003 to January 2005, 14 patients with coronary artery disease ( mean age of 62 +/- 5 years, female to male ratio 2: 12) were operated with the intention to perform a beating heart TECAB ( totally endoscopic coronary artery bypass grafting) procedure. Results: Total conversion rate was 35% (5/14), due to pleural adhesions in 2 patients, injury of the lung during port placement, inability to occlude the LAD with saddle loops, atherosclerotic diseased mammary artery in 1 patient each. Mean operating time was 298 +/- 110 minutes with a steady decline throughout the study period (first 5 patients: 342 +/- 61 minutes, patients 6 to 9: 337 +/- 87 minutes, last 4 patients: 290 +/- 53 minutes), resulting in a 60 minute shorter operating time. Mean ICU stay was 1.3 days and hospital stay lasted on average 8.4 +/- 2.8 days. Conclusion: Total endoscopic bypass surgery on the beating heart with the Da Vinci surgical system can be safely implemented in clinical use. The learning curve results in a constantly decreasing procedure time due to a more effective table team - console surgeon - robotic system interaction and a moderate conversion rate.