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Surgery Today

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01-02-2021 | Thoracoscopy | Original Article

Feasibility of bilateral internal thoracic artery harvesting using the da Vinci SP system

Authors: Hubert Stein, Volkmar Falk

Published in: Surgery Today | Issue 2/2021

Abstract

Purpose

We conducted this study to investigate the feasibility of mobilizing the bilateral internal thoracic arteries (ITAs) using the da Vinci SP through a single intercostal incision and to compare the amount of rib spreading with that required for mini-thoracotomy procedures. We also evaluated the construction of an intrathoracic T-graft anastomosis using existing instrumentation of the SP system.

Methods

We harvested bilateral ITAs from two male cadavers via a single incision made in the fifth intercostal space using the da Vinci SP. A T-graft end-to-side anastomosis was created in one cadaver.

Results

The bilateral ITAs were harvested in less than 60 min and a T-graft was completed. No additional rib spreading was required. Intraoperative adjustments of the da Vinci SP were necessary to maintain alignment with the surgical targets.

Conclusions

Bilateral ITA harvest using the da Vinci SP through a single intercostal incision was feasible, with less rib spreading than in mini-thoracotomy procedures. Thus, creating an intrathoracic T-graft with the existing da Vinci SP instruments is possible.

Davierwala PM, Mohr FW. Bilateral internal mammary artery grafting: Rationale and evidence. Int J Surg. 2015;16:133–9.CrossRef

Gaudino M, Chikwe J, Falk V, Lawton JS, Puskas JD, Taggart DP. Transatlantic editorial: the use of multiple arterial grafts for coronary revascularization in Europe and North America. Eur J Cardiothorac Surg. 2020. https://doi.org/10.1093/ejcts/ezaa077(Epub ahead of print).CrossRefPubMed

Buttar SN, Yan TD, Taggart DP, Tian DH. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart. 2017;103(18):1419–26.CrossRef

Park SY, Stein H, Heo SY. Preclinical, cadaveric study of the application of da Vinci single port system in thoracic surgery. J Thorac Dis. 2019;11(12):5586–91.CrossRef

Grimminger PP, van der Sluis PC, Stein H, Lang H, van Hillegersberg R, Egberts JH. Feasibility of transcervical robotic-assisted esophagectomy (TC-RAMIE) in a cadaver study—a future outlook for an extrapleural approach. Appl Sci. 2019;9:3572.CrossRef

Khoo A, Rosich-Medina A, Woodham A, Jessop ZM, Di Candia M, Malata CM. The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure. Microsurg. 2014;34(6):448–53.CrossRef

Reser D, Holubec T, Caliskan E, Guidotti A, Maisano F (2013) Left anterior small thoracotomy for minimally invasive coronary artery bypass grafting. Multimed Man Cardiothorac Surg. https://mmcts.org/tutorial/84. https://orcid.org/doi:10.1093/mmcts/mmv022. Accessed 25 Mar 2020

Ziankou AA, Ostrovsky YP (2017) Multi-vessel small thoracotomy coronary artery bypass using in situ bilateral internal thoracic arteries and right gastroepiploic artery. Multimed Man Cardiothorac Surg. https://mmcts.org/tutorial/562. https://orcid.org/doi:10.1510/mmcts.2017.004. Accessed 25 Mar 2020

Kotowicz V, Posatini R, Fortunato G, Battellini R. How to perform a MIDCAB procedure step-by-step in single vessel disease. Ctsenet Org. 2018. https://doi.org/10.25373/ctsnet.6713054.CrossRef

10.

Nambiar P, Kumar S, Mittal CM, Saksena K. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg. 2018;155(1):190–7.CrossRef

11.

Kikuchi K, Une D, Endo Y, Matsuyama T, Fukuda Y, Kurata A. Minimally invasive coronary artery bypass grating using bilateral in situ internal thoracic arteries. Ann Thorac Surg. 2015;100(3):1082–4.CrossRef

Title: Feasibility of bilateral internal thoracic artery harvesting using the da Vinci SP system
Authors: Hubert Stein
Volkmar Falk
Publication date: 01-02-2021
Publisher: Springer Singapore
Keywords: Thoracoscopy
Incision
Thoracotomy
Published in: Surgery Today / Issue 2/2021
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-020-02094-4

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Springer Medicine

Feasibility of bilateral internal thoracic artery harvesting using the da Vinci SP system

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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