Establishing a robotic coronary artery bypass surgery program: a narrative review

摘要

Background and Objective: Robotic coronary artery bypass surgery is an established procedure for treatment of coronary artery disease. The goal of this manuscript is to provide an overview on how to build a successful robotic coronary artery bypass grafting (CABG) surgery program and analyze its learning curve. Methods: We performed a narrative review of the current medical literature comparing the robotic CABG survival rate. English literature published by January 30th, 2021 were searched in PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL and Google Scholar. Key Content and Findings: The learning curve of robotic CABG is a stepwise process ranging from proficiency in off-pump CABG to multi-vessel robotic totally endoscopic CABG. Robotic CABG creates a unique setting where all the team members (including surgeons, anesthesiologists, and nurses) face the technical and logistic challenges of a new procedure, relying on the team assistance and medical knowledge. A careful selection of the team based on their experience and keen interest in the program is highly advisable. Team synergy and attention to details are key to the program success. It is recommended that every team member had previous training in the operating room with the robotic platform either on cadavers or animals. A synergistic collaboration among surgeon, hospital administration, and chief of the department through defining reasons are keys for developing a successful robotic surgical program and setting future goals for the team and the department. In addition, the ideal pathway of a successful trainee for patient selection consists of: (I) patient with stable coronary artery disease; (II) double vessels disease with a non-anterior descending artery (LAD) target that can be treated with stent; (III) robotic CABG left internal thoracic artery (LITA) to LAD followed by stenting of the non-LAD territory with angiographic confirmation of LITA to LAD patency; (IV) adding a second internal thoracic artery (ITA) should be evaluated carefully and after performing at least 75/100 cases of single LITA to LAD. In addition, literature review found 46 studies and 9,228 patients were included. Conclusions: Robotic CABG is a constantly evolving field and new programs are constantly built. Bearing in mind the benefits of the procedure, a stepwise growing of the program is essential in becoming a leader in the field.