Abstract
DESPITE PROGRESS made by interventional cardiologists and advances in pharmacotherapy of ischemic heart disease, surgical coronary revascularization remains the most effective method of treatment for patients with significant coronary artery disease (CAD). Because coronary artery bypass graft (CABG) surgery has been routinely performed and standardized, the focus of research and development has shifted to strategies for reducing surgical stress, trauma, and procedure-related complications. The introduction of endoscopic techniques developed in general surgery, orthopedics, and thoracic surgery and the development of new technology specific to cardiac surgery (eg, port access) led to the development of minimally invasive cardiac surgery. Minimally invasive cardiac surgery for CAD became popular with patients and some clinicians based on hopes of superior cosmetic results, faster patient recovery, and possible cost savings. Unfortunately, attempts to use existing endoscopic equipment in cardiac surgery have not resulted in the routine use of these procedures. Barriers to the widespread use of endoscopic cardiac surgery included poor visualization, problems with eye-hand coordination, use of 2-dimensional vision with subsequent loss of depth perception, fulcrum effect (movement of the instrument tip in direction opposite to the surgeon’s hands), imprecision and lack of dexterity because of significant operator fatigue, and interference and amplification of natural hand tremor. Now, minimally invasive cardiac surgery techniques have been further extended with the use of robotic technology and have led to a renewed interest in closed chest cardiac surgery as a possible routine procedure.
Published Version
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