Robotic Bilateral Internal Mammary Artery Dissection From Left Chest for Use as In-Situ Graft in Robot Assisted Coronary Artery

This article is part of CTSNet’s Guest Editor Series, “Robotic-Assisted Coronary Artery Bypass Graft Surgery—Techniques and Procedures” Dr. M. M. Yusuf brought together cardiac surgery experts from around the world to contribute procedure videos on various techniques.

Traditionally, coronary artery bypass surgery (CABG) involves harvesting the left internal mammary artery (LIMA) for grafting the left anterior descending artery (LAD). Robotic-assisted CABG offers a minimally invasive alternative with the potential benefit of using the right internal mammary artery (RIMA) as well without increasing the risk of sternal infections. This minimally-invasive technique utilizes the Da Vinci system to dissect bilateral internal mammary arteries (BIMA) using ports placed along the left hemithorax. The RIMA is left attached at its superior aspect and brought underneath the sternum to reach the diseased LAD. This technique, called "in-situ grafting," avoids severing the artery, potentially improving blood flow and long-term graft patency. The robot’s high-definition 3D visualization allows for precise dissection of the delicate RIMA with minimal bleeding. The robotic arms offer greater dexterity and maneuverability compared to traditional techniques, enabling access to the RIMA through a smaller incision in the left chest. 

References

1. Pande S, Agarwal SK, Gupta D, et al. Early and mid-term results of minimally invasive coronary artery bypass grafting. Indian Heart J. 2014;66(2):193-196. doi:10.1016/j.ihj.2014.02.010.
2. Gong W, Cai J, Wang Z, et al. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting. J Thorac Dis. 2016;8(3):459-468. doi:10.21037/jtd.2016.02.67.

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