Surgical Notes: Robotic Bilateral Thoracic Arteries Harvest

Robotic approach allows to harvest bilateral thoracic arteries using 5 ports (8 or 12 mm) in the left chest with no thoracotomy or sternotomy. This allows for a quick recovery with early post-operative discharge from the hospital (POD 2 or 3) and a quick return to daily activity: the absence of any thoracotomy or sternotomy makes the post-operative pain minimal and return to daily activity the quickest among any other minimally invasive coronary bypass surgical approach.

By adopting a robotic platform, surgeons can harvest both thoracic artery conduits nullifying the risk of sternal wound infection. Independently from BMI, gender or HbA1C, bilateral thoracic arteries (BITA) can be chosen as the grafts of choice in all comers. The only relative contra indication for robotic BITA take down are: 1) previous left thoracic surgery and 2) intolerance to single lung ventilation.

The international reports of BITA harvest via thoracotomy or endoscopically assisted have showed a very complex selection criteria required for such techniques due to the challenging in visualizing the mammary arteries via a small thoracotomy and the difficulties in maneuvering the long-shafted instrument inside the chest cavity. The robot allows increased operative dexterity and tremor-free movement with high-powered, magnified vision. Articulating instruments move with seven degrees of freedom and do not face the fulcrum effect which is typical of long-shafted, endoscopic instruments.

In a closed chest environment, the RITA is actually closer to the heart than generally perceived in an open sternotomy case and can reach left side targets passing underneath the anterior mediastinal fat. Finally, the value of BITA conduits even in incomplete revascularization has been proved to be superior to single internal thoracic artery and multiple veins coronary surgery even when the latter achieve complete revascularization.

We present here the detailed techniques and surgical notes on how to harvest bilateral thoracic arteries by using a robotic platform. We decided to divide the steps into 5 checklists that needs to be completed to achieve the final goal of obtaining two excellent grafts ready to be deployed on the heart.

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