Use of Bilateral Internal Thoracic Arteries in CABG Through Lateral Thoracotomy With Robotic Assistance in 150 Patients Sudhir Srivastava, MD, Suresh.

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Use of Bilateral Internal Thoracic Arteries in CABG Through Lateral Thoracotomy With Robotic Assistance in 150 Patients Sudhir Srivastava, MD, Suresh Gadasalli, MD, Madhava Agusala, MD, Ram Kolluru, MD, Jayaram Naidu, MD, Manish Shroff, MD, Reyna Barrera, PAC, Shaune Quismundo, RN, Vishwa Srivastava, BA The Annals of Thoracic Surgery Volume 81, Issue 3, Pages 800-806 (March 2006) DOI: 10.1016/j.athoracsur.2005.08.044 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Skin markings showing port positioning for the camera arm in the fifth intercostal space (5th ICS), left instrument arm in the seventh intercostal space (7th ICS), and right instrument arm in the third intercostal space (3rd ICS). The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Completed dissection of right internal thoracic artery (RITA) and left internal thoracic artery (LITA) and pericardiotomy showing left anterior descending artery (LAD) through left thoracotomy. The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Exposure and completed anastomosis of left internal thoracic artery (LITA) to left anterior descending artery (LAD). The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Exposure and completed anastomosis of saphenous vein graft (SVG) to right coronary artery (RCA) through left thoracotomy. The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Exposure and completed anastomoses of obtuse marginal branch one (OM1) and obtuse marginal branch two (OM2) with left internal thoracic artery (LITA) through left thoracotomy. The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Comparison of pain score showing variable levels of pain at intervals of postoperative day 1 (dark blue bars), day 7 (orange bars), day 30 (yellow bars), and day 90 (green bars). Significant reduction of pain was noted after postoperative day 7. The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Computed tomography angiogram at 3-month follow-up showing opacity beyond anastomoses, indicating graft patency. The Annals of Thoracic Surgery 2006 81, 800-806DOI: (10.1016/j.athoracsur.2005.08.044) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions