Cardiac MR in Robotic Heart Surgery for Preoperative Identification of the Target Vessel and Precise Port Placement - A Theoretical Model

P. Bergmann; S. Huber; H. Segl; H. Maechler; U. Reiter; G. Reiter; R. Rienmueller; P. Oberwalder; B. Rigler

doi:10.1055/s-2003-42263

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2003; 51(4): 204-210
DOI: 10.1055/s-2003-42263

Original Cardiovascular

Cardiac MR in Robotic Heart Surgery for Preoperative Identification of the Target Vessel and Precise Port Placement - A Theoretical Model

P. Bergmann¹ , S. Huber¹ , H. Segl¹ , H. Maechler¹ , U. Reiter² , G. Reiter² , R. Rienmueller² , P. Oberwalder¹ , B. Rigler¹

¹Department of Cardiac Surgery
²Department of Radiology, University Hospital Graz, Austria

Presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Leipzig, Germany, February 23 - 26 2003

Abstract

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Abstract

Background: The identification of the ideal anastomosis site and the proper port placement are critical for the success of closed-chest robotic surgery. We investigated a new systematic procedure for precise port placement for TECABs. Methods: We used trigonometry and a human thoracic model to determine the optimal working angles between anastomotic plane, instruments, and endoscope. We then applied the results to seven human subjects as follows: 1. A navigation grid was located extrathoracically before cardiac MR examination. 2. The ideal anastomosis site was defined with the MR. Intrathoracic distances and angles were computed with cardiac MR software and projected onto the thorax. 3. The ideal port placement points were marked on the thorax. Results: The optimal working angle between endoscope and instruments was 35°. 0° and 90° angles were associated with a significant reduction in visualization, technical ease, quality and anastomosis time. The course of the LAD was identified in all seven volunteers with MR. Mean deviation of the endoscope port from the medioclavicular line was 4.3 ± 2.1 cm and of the instrument ports from the anterior axillary line 8.4 ± 2.4 cm. Conclusions: Cardiac MR in combination with the navigation grid proved suitable for the visualization of coronary vessels for individually calculating port placement points on the thorax.

Key words

Robotic surgery - navigation - port placement - TECAB

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Referenzen

References

1 Böhm D H, Reichenspurner H, Gulbins H. et al . Early experience with robotic technology for coronary artery surgery. Ann Thorac Surg. 1999; 68 1542-1546
2 Boyd W D, Rayman R, Desai N D. et al . Closed-chest coronary artery bypass grafting on the beating heart with the use of a computed-enhanced surgical robotic system. J Thorac Cardiovasc Surg. 2000; 120 807-809
3 Chitwood W R. Endoscopic robotic coronary surgery - is this reality or fantasy? Editorial. J Thorac Cardiovasc Surg. 1999; 118 1-3
4 Kappert U, Schneider J, Cichon R. et al . Wrist-enhanced instrumentation: Moving towards totally endoscopic coronary artery bypass grafting. Ann Thorac Surg. 2000; 70 1105-1108
5 Falk V, Diegeler A, Walther T. et al . Total endoscopic computer enhanced coronary artery bypass grafting. Eur J Cardio-Thorac Surg. 2000; 17 38-45
6 Loulmet D, Carpentier A, d'Attelis N. et al . Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg. 1999; 118 4-10
7 Damiano R J, Ehrmann W, Ducko C, Tabaie H. Initial united states clinical trial of robotically assisted endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000; 119 77-82
8 Susilo A W, Schulz A P. Totally robotic technique in multivessel coronary disease - is it possible?. Asian Cardiovasc Thorac Ann. 2002; 10 92-94
9 Cichon R, Kappert U, Schneider J. et al . Robotically Enhanced ”Dresden Technique” with Bilateral Internal Mammary Artery Grafting. Thorac Cardiov Surg. 2000; 48 189-192
10 Dougan S, Aybek T, Khan M F. et al . Computer-Enhanced Telemanipulation Enables a Variety of Totally Endoscopic Cardiac Procedures. Thorac Cardiov Surg. 2002; 50 281-286
11 Kappert U, Cichon R, Schneider J. et al . Technique of closed chest coronary artery surgery on the beating heart. Eur J Cardio-Thorac Surg. 2001; 20 765-769
12 Mohr F, Falk V, Diegeler A. et al . Computer-enhanced robotic cardiac surgery: experienced in 148 patients. J Thoracic Cardiovasc Surg. 2001; 121 842-853
13 Damiano R J, Tabaie H A, Mack M J. et al . Initial prospective multicenter clinical trial of robotically-assisted coronary artery bypass grafting. Ann Thorac Surg. 2001; 72 1263-1269
14 Kappert U, Schneider J, Cichon R. et al . Development of robotic enhanced endoscopic surgery for the treatment of coronary artery disease. Circulation. 2001; 104 (suppl I) I-102-I-107
15 Reiter G, Reiter U, Rienmueller R. et al . Magenetic resonance imaging based planning of port placement for totally endoscopic coronary artery bypass grafting. European Radiology. 2003; 13 (Suppl. 1) 244
16 Damiano R J, Tabaie H A, Mack M J. et al . Initial prospective multicenter clinical trial of robotically-assisted coronary artery bypass grafting: Discussion. Ann Thorac Surg. 2001; 72 1263-1269
17 Tabaie H A, Reinbolt J A, Graper W P. et al . Endoscopic coronary artery bypass graft (ECABG) procedure with robotic assistance. The Heart Surgery Forum. 1999; 2 (4) 310-317
18 Gulbins H, Reichenspurner H, Becker C h. et al . Preoperative 3D-reconstructions of ultrafast-CT images for the planning of minimally invasive direct coronary artery bypass operation (MIDCAB). The Heart Surgery Forum. 1998; 1 (2) 111-115
19 Hanna G B, Cuschieri A. Influence of the optical axis-to-target view angle on endoscopic task performance. Surg Endosc. 1999; 13 371-375
20 Byhahn C, Mierdl S, Meininger D. et al . Hemodynamics and gas exchange during carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting. Ann Thorac Surg. 2001; 71 1496-1502

Peter BergmannMD

Department of Cardiac Surgery, University Hospital Graz

Auenbruggerplatz 29

48036 Graz, Austria

Telefon: +43/316/385-4671

Fax: +43/316/385-4672

eMail: peter.bergmann@kfunigraz.ac.at