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Bonatti, Johannes1; Schachner, Thomas1; Bonaros, Nikolaos1; Oehlinger, Armin1; Ruetzler, Elisabeth1; Jonetzko, Patrycja1; Friedrich, Guy2; Kreaden, Usha3; Feuchtner, Gudrun4; Pachinger, Otmar2; Laufer, Guenther1
1Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria, 2Cardiology, Innsbruck Medical University, Innsbruck, Austria, 3Intuitive Surgical, Sunnyvale, CA, USA, 4Radiology II, Innsbruck Medical University, Innsbruck, Austria
Robotic totally endoscopic coronary artery bypass grafting (TECAB) has so far been limited by long OR times and high conversion rates. We investigated whether specific surgical measures taken during the learning curve can influence procedural performance.
From 2001 to 2005 60 patients underwent endoscopic left internal mammary artery to left anterior descending artery grafting using the daVinci™ telemanipulation system and remote access perfusion. The following measures were taken with the intent to improve procedure performance: 1) introduction of a fixed team of surgeons at case 14, 2) application of fibrin glue to seal the anastomosis at case 28, 3) use of a 4th port for transthoracic assistance at case 49
Over this 60 patient series operative time was significantly reduced y(min)=546–57 x ln(x) x= TECAB Nr. (p<0.001). The occurrence of surgical errors was nonsignificantly reduced throughout the learning curve but problem severity level (on a scale of 5) fell from 1.3 during the first 40 cases to 0.4 during the last 20 cases (P=0.002). Use of a stable OR-team as well as application of fibrin glue reduced the conversion rate from 39% to 9% (P=0.018) and from 26% to 6% (P=0.032) respectively. Use of an additional port has so far not shown an effect on adverse events.
With increasing case number problem severity level falls during implementation of TECAB on the arrested heart. Use of a stable OR-team as well as sealing the anastomosis with fibrin glue can lead to a reduction of conversion rates.
© 2006 Lippincott Williams & Wilkins, Inc.
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