Perioperative Patient Management in Mammary Coronary Bypass Surgery Using Da Vinci Surgical System

Abstract

Introduction . Minimally invasive surgical techniques, including robot-assisted ones, on the one hand, allowed indications for surgery to be expanded, but on the other hand, generated a number of specific problems associated with technical aspects of minimally invasive treatment. The latter has led to a new consideration of the influence of surgical aggression on patients and showed a clear need for adequate anaesthetic support in order to correct homeostasis changes and ensure safety of patients. Aim. To improve the patient safety in mammary coronary bypass surgery using the Da Vinci robotic surgical system. Materials and methods. The study enrolled 12 patients who underwent robot-assisted endoscopic isolation of the left internal mammary artery, followed by an anastomosis of the anterior descending branch via a mini-thoracotomy in the fifth intercostal space under single lung sevoflurane inhalation anesthesia with continuous ESP analgesia. Results and discussion . No lethal outcomes or serious complications such as myocardial infarction and acute cerebrovascular accident were reported. Discharge or transfer to the rehabilitation unit was carried out on the 5th–7th day. Conclusion . Minimally invasive techniques, including robot-assisted ones, require that the intensivists and cardiac surgeons be aware of the pathophysiological factors that affect the cardiovascular and respiratory systems, and have the ability to predict the course of events and take actions to prevent complications.