Totally endoscopic coronary artery bypass grafting (TECAB)

Totally endoscopic coronary artery bypass grafting (TECAB)

Totally endoscopic coronary artery bypass grafting (TECAB) is done with precision using robotic surgery equipment [1]. Unlike conventional coronary artery bypass grafting (CABG) which is done through a midline sternotomy, TECAB is done through four to five small ports with the help of the da Vinci Surgical System. The da Vinci robotic system is a highly advanced tool which helps the surgeon sitting in the equipment console to control the robotic surgery arms. Tiny video cameras attached to robotic arm give a detailed three dimensional view of the operating field inside the thoracic cavity. Robotic endostabilizer is available for beating heart surgeries. Multivessel procedures can be done as well as total arterial revascularization using both left and right internal mammary arteries. Sequential grafting and Y grafting are also technically feasible. Radial artery and vein grafts can be inserted using TECAB. But multivessel procedures are time consuming and may get conventional large incision CABG [2]. Still triple vessel beating heart TECAB for targets on lateral and posterolateral wall of left ventricle has been reported [3].

Robotic off-pump TECAB is the least invasive form of surgical coronary revascularization. Data from 544 patients undergoing TECAB between 2013 and 2020 has been reported in a retrospective analysis [4]. Mean age was 66 years and mean STS risk was 1.7%. Of these persons, 56% had multivessel TECAB. There was only one conversion to sternotomy and 46% had extubation in the operating room. At mid-term follow up of 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%.

Reference

1. Bonatti J, Vento A, Bonaros N, Traina M, Lehr E. Robotic totally endoscopic coronary artery bypass grafting (TECAB)-placement of bilateral internal mammary arteries to the left ventricle. Ann Cardiothorac Surg. 2016 Nov;5(6):589-592.
2. Bonatti J, Lee JD, Bonaros N, Schachner T, Lehr EJ. Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results. Innovations (Phila). 2012 Jan-Feb;7(1):3-8.
3. Brownlee AR, Amabile A, Torregrossa G, Balkhy HH. Robotic totally endoscopic triple bypass with bilateral internal mammary arteries and two different anastomotic techniques. J Card Surg. 2022 Jan;37(1):249-251. doi: 10.1111/jocs.16112. Epub 2021 Nov 7. PMID: 34747050.
4. Balkhy HH, Nisivaco S, Kitahara H, Torregrossa G, Patel B, Grady K, Coleman C. Robotic off-pump totally endoscopic coronary artery bypass in the current era: report of 544 patients. Eur J Cardiothorac Surg. 2021 Aug 15:ezab378. doi: 10.1093/ejcts/ezab378. Epub ahead of print. PMID: 34392341.