Early Experience of Robotic-Assisted Coronary Artery Bypass Grafting

機器人輔助冠狀動脈繞道手術之早期經驗

蔡建松(Chieh-Sung Tsai) ； 蘇銓男(Chuan-Nan Su) ； 林致源(Chih-Yuan Lin) ； 洪國峻(Gou-Jieng Hong) ； 孫光煥(Guang-Huan Sun) ； 于大雄(Dah-Shyong Yu) ； 羅時鴻(Shih-Hurng Loh)

《Acta Cardiologica Sinica》 22卷3期 (2006/09) Pp. 154-158

摘要

目的　機器手臂輔助手術促使微創手術蓬勃發展。且已用在經由小傷口的開胸手術來完成冠狀動脈繞道手術的血管接合。這篇報告主要是分享我們使用機器手臂輔助冠狀動脈繞道手術的早期經驗。
方法　經由達文西機器手臂系統輔助，由左胸前小傷口開胸術完成左內胸動脈至左前降枝冠狀動脈的繞道手術。機器手臂系統是用來取下左內胸動脈，血管接合是在心臟不停跳之下，由左前胸小傷口開胸術完成。
結果　從2005年1月至9月，共10位病人。平均年齡為59歲，左心室射出分率為62%。其中2位病人接受二條冠狀動脈繞道手術，第二條是由橈動脈橋接左內胸動脈至左前降枝之分枝。術後除了一例是因左側肋膜積水而再次入院外，並無特殊的併發症。平均加護病房住院天數為2.2天，平均術後住院天數為7.1天。
結論　這篇報告結果顯示出使用機器手臂輔助之冠狀動脈繞道手術有短期良好之預後。且促使我們將來能全程由達文西機器手臂系統來完成冠狀動脈繞道手術。

關鍵字

冠狀動脈繞道手術 ； 機器人輔助 ； 外科

並列摘要

Purpose: Robotics facilitates minimally invasive cardiac surgery, and has been used to perform portions of coronary artery anastomoses via minimal thoracotomy incisions. This report shares our early experience of robotic-assisted coronary artery bypass grafting.
Methods: The robotic-assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery to the left anterior descending artery was performed by using the da Vinci robotic system. Two robotic instruments and one endoscopic camera were placed through three small ports. A robotic system was used to harvest the left internal thoracic artery; anastomoses were performed directly through a left anterior minimal thoracotomy under off-pump coronary artery bypass.
Results: Between January 2005 and September 2005, the new instrumentation was used in 10 patients. The mean age of the patients was 59 years, and mean left ventricular ejection fraction was 62%. Two of the 10 patients received double coronary artery bypass grafts. They had a radial artery graft bridging the left internal thoracic artery to the diagonal branch through a small left anterior thoracotomy. No major complications were encountered in the postoperative period, except for one patient who was admitted because of left-side pleural effusion. The median length of stay in the intensive care unit was 2.2 days. The mdian postoperative hospital stay was 7.1 days.
Conclusion: The results from this prospective clinical trial in our hospital showed favorable short-term outcome with no adverse events. Robotic assistance enables us to perform totally off-pump endoscopic coronary artery bypass.

並列關鍵字

Coronary artery bypass ； Robotics ； Surgery