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, Table of Contents

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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Peter BergmannMD

Department of Cardiac Surgery, University Hospital Graz

Auenbruggerplatz 29

48036 Graz, Austria

Phone: +43/316/385-4671

Fax: +43/316/385-4672

Email: peter.bergmann@kfunigraz.ac.at