The Utility of a 3D Endoscope and Robot-Assisted System for MIDCAB.
BACKGROUND
Minimally invasive direct coronary artery bypass (MIDCAB) has been revived with new techniques and hybrid procedures for MIDCAB and percutaneous coronary intervention (PCI). We reviewed the midterm results of MIDCAB with a three-dimensional (3D) endoscope in our institution.


METHODS
Of the 359 patients who underwent off-pump coronary artery bypass grafting (CABG) from December 2013 to March 2017, 54 had MIDCAB with the left internal thoracic artery (LITA) to left anterior descending (LAD) artery through a small left thoracotomy with a 3D endoscope. The same intercostal space was used for the main surgical incision and the insertion site of the 3D endoscope. In all, 22 patients had hybrid coronary revascularization (HCR), combined PCI and MIDCAB.


RESULTS
There was no operative death. One patient had cerebral infarction without disability. No cases showed significant increases in CKMB. In all, 34 patients commenced ambulation on postoperative day 1. The postoperative hospital stay was 9.1 ± 5.0 days. In total, 37 patients had coronary computed tomography (CT), and their patency of LITA was 100%. In HCR, there was no mortality and major adverse cardiovascular event (MACE). Target lesion revascularization among 12 months was 1.6%.


CONCLUSION
The midterm results of MIDCAB with 3D endoscope-assisted LITA harvesting were satisfactory. MIDCAB, including HCR, is a good alternative for selected high-risk patients.
['Endo|Yuki|Y|', 'Nakamura|Yoshitsugu|Y|', 'Kuroda|Miho|M|', 'Ito|Yujiro|Y|', 'Hori|Takaki|T|']
D000368:Aged D000369:Aged, 80 and over D047549:Coronary Artery Bypass, Off-Pump D003324:Coronary Artery Disease D004867:Equipment Design D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D008323:Mammary Arteries D008875:Middle Aged D062645:Percutaneous Coronary Intervention D020127:Recovery of Function D065287:Robotic Surgical Procedures D020708:Thoracoscopes D013906:Thoracoscopy D013997:Time Factors D020858:Tissue and Organ Harvesting D016896:Treatment Outcome D014654:Vascular Patency
endoscope robot-assisted system minimally invasive direct coronary artery bypass hybrid coronary revascularization