[Abstract] [Full Text HTML] [Full Text PDF] (in Japanese / 2264KB) [PDF: Members Only]

J.Jpn. Surg. Soc.. 124(4): 342-347, 2023

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Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan

Tomoyuki Fujita

In the past two to three decades, progress in minimally invasive cardiac surgical techniques has been possible due to advances in cardiopulmonary bypass, instrument design, and robotic surgical platforms. Robotic coronary artery bypass grafting (RCABG) has emerged as a minimally invasive technique for patients with coronary artery disease. RCABG eliminates the need for sternotomy and is associated with fewer complications, shorter hospital stays, and earlier return to work and functional activity. However, RCABG is a technically demanding surgery, although robotic internal thoracic artery (ITA) harvesting is not. ITA harvesting is the first step for RCABG. For the anastomosis, the U-Clip (Medtornic Inc., Minneapolis, MN) and Cardia Flex-A device (AesDex/B Braun, Tutlingen, Germany) were previously available (but are not now) to make coronary anastomosis easier and to shorten operation time. Since these are no longer available, anastomosis should now be formed manually. Recently, hybrid revascularization has become more standard, in which two ITAs are anastomosed to the coronary arteries on the left side and percutaneous coronary intervention is performed, mainly on the right side. With the advantages of ITA grafts, the short- and long-term outcomes are favorable, and this suggests the promising future of RCABG.

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