Transabdominal endoscopic computer-enhanced coronary artery bypass grafting

Background. Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. Methods. A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left (n = 10) and right internal thoracic arteries (n = 5) was performed. Coronary anastomoses were performed remotely and unassisted. In an animal model the hemodynamic consequences of the approach were assessed. Results. In all cadavers TCAB was achieved through three abdominal ports. Time for internal thoracic arteries harvest was 48 +/- 13 minutes (left) and 39 +/- 10 minutes (right). Intimal dissection was found in one graft. Time for anastomosis was 23 +/- 9 minutes and 27 +/- 10 minutes for the left anterior descending (n = 10) and right coronary artery (n = 5), respectively. All anastomoses were patent. Opening the diaphragm in living animals led to a decrease of systolic blood pressure by 30 +/- 16 mm Hg, but resolved with appropriate treatment. Conclusions. TCAB is possible in cadavers using computer-enhanced telemanipulation technology. The transabdominal approach is a promising access for less invasive cardiac surgery. (C) 1999 by The Society of Thoracic Surgeons.