caa a22 4500 46795271X CHVBK 20180405193744.0 cr unu---uuuuu 170328e20041101xx s 000 0 eng 10.1007/BF02637125 doi (NATIONALLICENCE)springer-10.1007/BF02637125 (NATIONALLICENCE)springer-10.1007/s00464-003-9193-7 Totally endoscopic coronary artery bypass graft [Elektronische Daten] Initial experience with an additional instrument arm and an advanced camera system [S. Dogan, T. Aybek, P. Risteski, S. Mierdl, H. Stein, C. Herzog, M. Khan, O. Dzemali, A. Moritz, G. Wimmer-Greinecker] Background: Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback, traction, or counter-traction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature. Methods: The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagnonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative field beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon. Results: The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195±58, 25±10, and 18±5 min, respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique. Conclusions: The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community. Springer Science+Business Media, Inc, 2004 Cardiac surgery nationallicence Robotic telemanipulation nationallicence Totally endoscopic coronary artery bypass nationallicence Endoscopic surgery nationallicence Dogan S. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Aybek T. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Risteski P. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Mierdl S. Department of Anaesthesiology, Intensive Care and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Stein H. Intuitive Surgical, Sunnyvale, CA, USA aut Herzog C. Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Khan M. Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Dzemali O. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Moritz A. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Wimmer-Greinecker G. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut Surgical Endoscopy And Other Interventional Techniques Springer-Verlag 18/11(2004-11-01), 1587-1591 0930-2794 18:11<1587 2004 18 464 https://doi.org/10.1007/BF02637125 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02637125 text/html Onlinezugriff via DOI NATIONALLICENCE 773 0- Surgical Endoscopy And Other Interventional Techniques Springer-Verlag 18/11(2004-11-01), 1587-1591 0930-2794 18:11<1587 2004 18 464 NATIONALLICENCE 700 1- Dogan S. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Aybek T. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Risteski P. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Mierdl S. Department of Anaesthesiology, Intensive Care and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Stein H. Intuitive Surgical, Sunnyvale, CA, USA aut NATIONALLICENCE 700 1- Herzog C. Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Khan M. Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Dzemali O. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Moritz A. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 700 1- Wimmer-Greinecker G. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany aut NATIONALLICENCE 856 40 https://doi.org/10.1007/s00464-003-9193-7 text/html Onlinezugriff via DOI NATIONALLICENCE 773 0- Surgical Endoscopy And Other Interventional Techniques Springer-Verlag; www.springer-ny.com 18/11(2004-11-01), 1587-1591 0930-2794 18:11<1587 2004 18 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE NATIONALLICENCE NL-springer