Robot Assisted Left Internal Thoracic Artery Harvesting in Minimally Invasive Direct Coronary Artery Bypass: Report of a Case

Abstract

Coronary artery bypass grafting (CABG) is usually performed through a sternotomy. Minimally invasive direct coronary artery bypass grafting (MIDCABG) has been used recently in a select group of patients with severe lesions of the left anterior descending (LAD) coronary artery. CABG has been proven difficult to adapt to a totally endoscopic approach because of the inability to perform a precision microvascular-sutured coronary anastomosis with conventional endoscopic instrumentation. The Da Vinci telemanipulation system has six degrees of freedom and allows free orientation in space and a remote, tremor-free, three-dimensional visual image. We report hereby a 76-year-old male who suffered from substernal chest pain that radiated to the left shoulder for one day. Coronary angiography confirmed coronary artery disease with 90% occlusion of the LAD coronary artery. The patient volunteered to receive the operation. Robotically assisted left internal thoracic artery (LITA) harvesting and direct off-pump anastomosis to the LAD through small thoracotomy incisions were performed safely. The patient improved clinically and was free of angina at the six-month follow-up. We describe an alternative procedure for one-vessel disease using robotic takedown of the LITA and off-pump anastomosis to the LAD artery through small incisions. This procedure is associated with minimal blood loss and ventilatory requirements, and short stays in the intensive care unit and hospital.