Go Watanabe

Robotic Internal Thoracic Artery Harvesting

PurposeGreat progress has been made in robotic surgery, and several reports on robot-assisted coronary artery bypass grafting (CABG) have been published. Our team at Kanazawa University began using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in 2005. We report our experience of using the da Vinci Surgical System for totally endoscopic internal thoracic artery (ITA) harvesting.MethodsBetween December 2005 and May 2006, we used the da Vinci Surgical System to harvest the ITA through three ports placed on the left side of the chest in 10 patients.ResultsAll 10 ITAs were harvested successfully in a skeletonized fashion. The robotic harvesting time was reasonable at 38.8 ± 25.2 min, and the average length of harvested ITA was 16.2 ± 3.1 cm. After computer-enhanced ITA harvesting, seven patients underwent off-pump CABG and three patients underwent minimally invasive direct CABG. There was no mortality, and the postoperative patency rate of all grafts was 100%.ConclusionsThe da Vinci Surgical System provides a high-resolution stereoscopic image and allows remote, tremor-free, and scaled control of endoscopic surgical instruments with seven degrees of freedom. Computer-enhanced ITA harvesting was performed safely with excellent results.

Beating-heart totally endoscopic coronary artery bypass grafting: Report of a case

This case report presents beating-heart totally endoscopic coronary artery bypass grafting (TECAB) for single-vessel coronary artery disease. A 72-year-old man with isolated left anterior descending (LAD) coronary artery disease was considered eligible for TECAB. Left internal thoracic artery (LITA) mobilization and subsequent off-pump revascularization applying the LITA to the LAD in a closed chest environment was performed using the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA). The LITA was first harvested completely in a totally skeletonized fashion through three incisions 1–2 cm long in the left thoracic wall. The LAD was immobilized with the aid of a heart stabilizer. The LITA was then anastomosed to the LAD with 10 interrupted sutures of a Nitinol self-closing S15 U-clip device (Medtronic, Minneapolis, MN, USA) on the beating heart without the use of cardiopulmonary bypass. The time acquired to perform anastomosis was 20 min, and the total operative time was 5 h 34 min. The postoperative course was uneventful and the patient was discharged 5 days after the operation. Beating-heart TECAB was successfully performed for this patient with single-vessel LAD disease. This approach may be an evolutionary step toward beating-heart multivessel TECAB.

Commissural Autologous Pericardial Patch Repair: A Novel Technique for Active Mitral Valve Endocarditis Involving the Mitral Annulus

In patients with massive destruction caused by mitral endocarditis, surgical valve repair remains a challenging issue. Although several procedures have previously been introduced, no standard method for complicated lesions has been established. We describe a technique of mitral valve repair for extensive destructive endocarditis involving both leaflets and the mitral annulus that has provided satisfactory initial results in 2 patients. This procedure is believed to be technically simple and beneficial in terms of mitral repair for active endocarditis.

Origami using da Vinci Surgical System

Great progress has been made in the development of robotic surgical technology, but it is necessary to become skilled in using a robot. Among the advantages of a robot is practice in acquiring skill with stereoscopic three-dimensional (3D) imaging. We describe use of the da Vinci surgical system (Intuitive Surgical, Inc. Sunnyvale, CA) in developing necessary skills by practicing traditional Japanese Origami (paper folding), and we quantified the robotic-assisted dexterity.

Are You Ready to Take Off as a Robo-surgeon?

Robotic-assisted surgery is the latest iteration toward less invasive techniques. Surgeons have slowly adapted minimally invasive and robotics techniques into their armamentarium. We have developed a robotic cardiac surgery program in Japan that utilizes the da Vinci Surgical System, allowing the surgeon to perform complex procedures through 5-mm port sites rather than a traditional median sternotomy. In this rapidly evolving field, we review the evolution and clinical results of roboticassisted surgery and take a look at the other general surgical procedures for which da Vinci currently being used.

A novel internal thoracic artery harvesting technique via subxiphoid approach – for the least invasive coronary artery bypass grafting

We have performed 12 cases of robotically assisted coronary artery bypass grafting (CABG) to accomplish less invasive revascularization. In this report, we describe a new method of robotically assisted internal thoracic artery (ITA) harvesting via subxiphoid approach, using the da Vinci surgical system. A 22-year-old man with three-vessel coronary artery disease due to Kawasaki disease was referred to our institution for coronary artery revascularization. A small subxiphoid incision was made, and the xiphoid process at the lower end of the sternum was excised. A U-shaped hook was inserted into the retrosternal space, and the lower sternum was lifted. A 30 degrees angle-up camera was inserted under the U-shaped hook, bilateral ITAs were harvested in a totally skeletonized fashion endoscopically. The required time for right ITA harvesting was 50 min, and that for the left was 20 min. After bilateral ITAs were harvested, composite grafts were made, and then the distal anastomoses were made. The patient was discharged six days after the operation. We performed a new robotically assisted bilateral ITA harvesting technique via sub-xiphoid safely and with excellent results. This method might be an evolutionary step of minimally invasive direct coronary artery bypass (MIDCAB) using the da Vinci surgical system.

Mycotic aneurysm of the left anterior descending coronary artery after coronary artery bypass graft surgery.

Mycotic aneurysms of the coronary artery are extremely uncommon and can be very difficult to diagnose. We report a unique case of a mycotic aneurysm of the left anterior descending coronary artery with a history of two-vessel off-pump coronary artery bypass graft surgery 9 months previously. The aneurysmectomy was successful.

Totally endoscopic closure of an atrial septal defect using the da vinci surgical system: Report of four cases

This report presents four cases of totally endoscopic closure of an atrial septal defect using the da Vinci Surgical System (Intuitive Surgical, Mountain View, CA, USA). The patients were diagnosed with an ostium secundum atrial septal defect and elected to undergo minimally invasive surgery. A cardiopulmonary bypass was established via cannulation of the femoral vessel and jugular vein, and blood cardioplegic arrest was induced using a transthoracic cross-clamp. The mean extracorporeal circulation and cardiac arrest times were 86 ± 21 and 22 ± 8 min, respectively. No patient experienced pain after surgery, and all were fast-tracked for early discharge and released on postoperative day 3. No intraoperative or postoperative complications occurred. This procedure permitted a short hospital stay, quick return to an active lifestyle, and had an excellent cosmetic outcome. The success of this procedure therefore encourages that this procedure should be considered as day surgery.

Rerouting revascularization of the living right gastroepiploic artery graft in a patient with de novo gastric cancer

We present a case in which a redo patient in whom advanced gastric cancer was detected after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA), and in which re-grafting to the distal RGEA using the right internal thoracic artery (RITA) was performed. To minimize the surgical invasion before gastrectomy, we performed a thoracoscopic RITA harvest and small subxyphoid incision. A month later, distal gastrectomy was carried out and no complications occurred during the operation.

Surgical treatment of bilateral coronary-to-pulmonary artery fistulas

Bilateral coronary artery fistulas with the coronary artery stenosis are rare. In this case, we successfully performed closure of coronary artery fistulas with coronary artery bypass grafting. Furthermore, we were able to measure the flow in the coronary artery fistulas using transit-time flow measurement.