Kenji Kawachi

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.

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.

Two-Port Robotic Cardiac Surgery (TROCS) for Atrial Septal Defect (ASD) Using Cross-Arm Technique – TROCS ASD Repair –

BACKGROUND We successfully performed totally endoscopic atrial septal defect (ASD) repair via 2 ports, and we named this procedure two-port robotic cardiac surgery (TROCS).Methods and Results:A 51-year-old woman with secundum ASD underwent robot-assisted ASD repair under ventricle fibrillation without aortic cross-clamping. Two ports were placed in the right side of the chest, and 1 port was for the robotic endoscope. Two robotic instruments were inserted through another port and crossed while preventing them from colliding. CONCLUSIONS TROCS ASD repair using a cross-arm technique was achieved safely with good clinical results and excellent cosmetic results.

Robotic Skeletonized Internal Thoracic Artery Harvesting: The Sliding Fascia Technique

Robotic skeletonizing and harvesting of the internal thoracic artery, using the da Vinci surgical system, has a number of advantages over robotic pediculed ITA harvesting. The advantages include greater blood flow, a longer conduit, and less bleeding. The technique is facilitated by use of the EndoWrist spatula cautery and fine tissue forceps (Intuitive Surgical, Inc., Sunnyvale, CA, USA). How the technique is performed is described in this report.

Endoscopic Radial Artery Harvesting: Patient Satisfaction and Complications

Endoscopic radial artery harvesting was recently introduced to reduce the morbidity associated with conventional open harvesting and improve cosmetic outcomes. From January 2004 through December 2006, 25 radial arteries were harvested endoscopically from 25 patients using the VasoView endoscopic system. Bilateral radial arteries were harvested from 6 patients by both the endoscopic and open techniques, and postoperative patient satisfaction was assessed using a visual analogue scale. Mean harvesting time was 61.9 ± 16.0 min (range, 44–105 min), and mean harvested conduit length was 16.8 ± 2.0 cm (range, 15–19 cm). Objective dorsal thenar numbness remained in 2 patients (8%); none complained of forearm numbness. All patients expressed marked satisfaction with the endoscopic technique and the small incision. Patient satisfaction was significantly higher with the endoscopic technique than with the open technique (visual analogue scale of 9 vs 5). Postoperative angiography revealed occlusion of a graft that had been anastomosed to a small diagonal branch. The overall graft patency was 96.6%. Endoscopic radial artery harvesting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.

Robotic mitral valve plasty for mitral regurgitation after blunt chest trauma in Barlow's disease

We successfully treated a case of mitral regurgitation due to chest trauma in Barlows disease. A 71‐year‐old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo‐chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posterior mitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlows disease was achieved safely with good clinical and excellent cosmetic results.

How I do it: high-quality intraoperative fluorescence imaging in off-pump coronary artery bypass grafting.

We have developed a simple technique for establishing high-quality intraoperative fluorescence imaging in off-pump coronary artery bypass grafting. The technique of transaortic injection of indocyanine green is an effective method of achieving clear fluorescence imaging and for evaluating the quality of graft anastomoses. We consider the images obtained with this technique to be equivalent to those obtained by conventional coronary angiography with selective enhancement of the graft.

How I Do It: Modified Technique for Vein Preparation Using the SaphLITE Retractor and PAS-Port System

We describe a modified technique of vein preparation using the SaphLITE retractor and PAS-Port aortic connector system in off-pump coronary artery bypass. The combination of these devices can minimize leg wound complication, shorten time to harvest, and enable us to obtain reliable hemostasis.

How I do it: Traction of Ascending Aorta with Starfish Heart Positioner During Proximal Saphenous Vein Graft Anastomosis Using the PAS-Port System in Off-Pump Coronary Artery Bypass Grafting

The PAS-Port system allows for the rapid deployment of a clampless proximal anastomosis between a saphenous vein graft and the aorta. We have developed a simple technique of establishing traction of the ascending aorta with the Starfish heart positioner during proximal saphenous vein anastomosis using the PAS-Port system in off-pump coronary artery bypass grafting.