Original article
Adult cardiac
Training Surgeons to Perform Robotically Assisted Totally Endoscopic Coronary Surgery

https://doi.org/10.1016/j.athoracsur.2009.04.089Get rights and content

Background

Robotic totally endoscopic coronary bypass (TECAB) surgery was developed during the past decade, and younger surgeons need to be trained in this new modality. This study assessed the learning curves and independent TECAB performance of 2 junior surgeons undergoing TECAB training.

Methods

Two surgeons in training performed portions of 44 of 239 robotic TECAB operations, including left (LIMA) and right interior mammary artery (RIMA) harvesting, lipectomy, pericardiotomy, and IMA to left anterior descending coronary artery (LAD) anastomotic suturing.

Results

The procedure portions performed faster by the senior surgeon vs trainees were, in minutes (range), lipectomy, 5 (2 to 18) vs 10 (5 to 21; p < 0.001); pericardiotomy, 5 (1 to 21) vs 7 (3 to 16; p = 0.001); RIMA takedown, 35 (25 to 48) vs 49 (40 to 55; p = 0.034); and LIMA to LAD anastomosis, 26 (12 to 100) vs 34 (24 to 67; p = 0.043). After assuming senior roles in the robotic cardiac surgery program, the 2 trained surgeons performed 14 TECABs (LIMA to LAD) without the senior surgeon. Lipectomy took 5 (3 to 8) minutes; pericardiotomy, 5 (2 to 10) minutes; LIMA takedown, 43 (27 to 70) minutes; LIMA to LAD anastomosis, 24 (15 to 60) minutes, cardiopulmonary bypass time, 73 (40 to 126) minutes; and aortic endo-occlusion time, 53 (0 to 83) minutes. No hospital deaths occurred.

Conclusions

TECAB can be well taught with a stepwise training program involving portions of the procedure performed by trainees. With such an approach, independent performance after training can be within adequate time limits and yields seemingly acceptable results.

Section snippets

Patients and Methods

From 2001 to 2008, 239 patients underwent robotically assisted CABG operations. The procedures were AHTECAB in 161, beating heart TECAB in 11, minimally invasive direct CABG (MIDCAB) with endoscopically harvested left internal mammary artery (LIMA) in 10, and 57 underwent a conventional CABG operation through a sternotomy in which the left internal mammary artery (LIMA) was harvested robotically, or the LIMA to left anterior descending coronary artery (LAD) anastomosis was sutured with robotic

Results

Lipectomy took 5 minutes (range, 2 to 18 minutes) for the senior surgeon vs 10 minutes (range, 5 to 21 minutes) for the trainees (p < 0.001). Pericardiotomy time was 5 minutes (range, 1 to 21 minutes) for the senior surgeon vs 7 minutes (3 to 16 minutes) for the trainees (p = 0.001, Fig 1). The LIMA takedown time was comparable between the experienced surgeon and the trainees at 39 minutes (range, 19 to 180 minutes) vs 39 minutes (range, 20 to 80 minutes; p = 0.683, Fig 2), and RIMA takedown

Comment

TECAB has left its pioneer phase behind and now requires structured training programs. Some skills, such as accuracy and time required to complete a task, are successfully trained in laparoscopic general surgery. Virtual reality and video trainers are used preclinically to reduce the training phase in the operating room [12]. In our program, intensive dry-lab training with the robotic endoscopic device was done before the first clinical applications were begun. In addition, intensive

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Copyright © 2009 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.