Robotic totally endoscopic coronary artery bypass grafting: It's now or never!

Abstract

Central MessageRobotic totally endoscopic coronary bypass is a valuable technique in the current era. The future of this procedure depends on commitments from both our specialty and industry to make it successful.See Commentaries on pages 158 and 160. Robotic totally endoscopic coronary bypass is a valuable technique in the current era. The future of this procedure depends on commitments from both our specialty and industry to make it successful. See Commentaries on pages 158 and 160. Feature Editor's Introduction—Robotic totally endoscopic coronary artery bypass grafting represents the most advanced form of coronary surgery. After initial enthusiasm, the technique has not been largely adopted by the surgical community and it is currently performed by only a few technical masters. Dr Husam Balkhy presents a superb review of the technique and an important perspective on its possible future. I'm sure readers will enjoy reading it as much as I did. Mario Gaudino, MD, PhD, MSCE Totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. Outside of a very small number of experiences, it has only been successfully executed when coupled with robotic technology.1Lee J.D. Srivastava M. Bonatti J. History and current status of robotic TECAB.Circ J. 2012; 76: 2058-2065Crossref PubMed Scopus (32) Google Scholar The possibility of a sternal-sparing, port-only approach to coronary artery bypass grafting (CABG) surgery, which is arguably among the most commonly performed major surgical procedures over the past several decades, was extremely appealing when robotics first became available for clinical use in the late 1990s. Indeed, both of the surgical robot companies that came to life during that early era considered CABG to be their primary target for growth, as demonstrated by the fact that the first preclinical experiments involved coronary anastomoses,2Ducko C.T. Stephenson Jr., E.R. Sankholkar S. Damiano Jr., R.J. Robotically Assisted coronary bypass surgery: moving toward a completely endoscopic procedure.Heart Surg Forum. 1999; 2: 29-37PubMed Google Scholar and among the first cases performed was an arrested heart single vessel TECAB.3Loulmet D. Carpentier A. d'Attellis N. Berrebi A. Cardon C. Ponzio O. et al.Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.J Thorac Cardiovasc Surg. 1999; 118: 4-10Abstract Full Text Full Text PDF PubMed Scopus (380) Google Scholar Even the early-generation robotic systems offered a significant improvement over traditional thoracoscopic approaches for executing this highly complex procedure because of the superiority of 3-dimensional vision and instrument dexterity inside the chest. Later generations of the da Vinci robot (Intuitive Surgical, Sunnyvale, Calif) have only improved upon these features by adding a fourth arm, high-definition visualization, more specialized instrumentation, and smart technology for docking and avoiding arm conflicts. During the early to mid-2000s, there was a flurry of activity surrounding TECAB, including a Food and Drug Administration trial and approval,4Argenziano M. Katz M. Bonatti J. Srivastava S. Murphy D. Poirier R. et al.Results of the prospective multicenter trial of robotically assisted totally endoscopic CABG.Ann Thorac Surg. 2006; 81: 1666-1674Abstract Full Text Full Text PDF PubMed Scopus (151) Google Scholar as well as increasing program adoption of the technology as multiple groups reported their results with both arrested and beating heart TECAB.5Srivastava S. Gadasalli S. Agusala M. Kolluru R. Barrera R. Quismundo S. et al.Beating heart totally endoscopic coronary artery bypass.Ann Thorac Surg. 2010; 89: 1873-1879Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar, 6Bonatti J. Schachner T. Bonaros N. Oehlinger A. Weidemann D. Ruetzler E. et al.Effectiveness and Safety of Total endoscopic left internal mammary artery bypass graft to the left anterior