Harvesting bilateral internal thoracic arteries using a novel subxiphoid approach versus the conventional lateral thoracic approach—results of an experimental.

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Presentation transcript:

Harvesting bilateral internal thoracic arteries using a novel subxiphoid approach versus the conventional lateral thoracic approach—results of an experimental study Chikako Ikeda, MD, Go Watanabe, MD, PhD, Norihiko Ishikawa, MD, PhD, Hiroshi Ohtake, MD, PhD, Shigeyuki Tomita, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 2, Pages 461-467 (August 2014) DOI: 10.1016/j.jtcvs.2013.09.039 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Phase I: dry-laboratory model, baseline setting. A 30° angle-up camera was used. A, Distance between instrument ports (10 cm or 6 cm). B, Vertical distance between the camera port and the instrument ports (1 cm or 0 cm). RITA, Right internal thoracic artery; LITA, left internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 461-467DOI: (10.1016/j.jtcvs.2013.09.039) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Phase I: dry-laboratory model showing analysis of the horizontal and vertical movement area (polygonal area) of the arm. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 461-467DOI: (10.1016/j.jtcvs.2013.09.039) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Positioning of the robotic system, camera, and instrument ports for the subxiphoid, linear harvesting technique. A, The surgical cart was placed at the head of the table. The instrument ports were placed symmetrically to the right and left of the subxiphoid incision, under direct vision through the camera. B, The chest wall was lifted, and the working space was created. RITA, Right internal thoracic artery; LITA, left internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 461-467DOI: (10.1016/j.jtcvs.2013.09.039) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Operator's view on the console during the subxiphoid approach. A, The left internal thoracic artery (LITA) trunk and branches. B, Branching of the subclavian artery from the LITA. C, Free LITA grafts. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 461-467DOI: (10.1016/j.jtcvs.2013.09.039) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Phase I: dry-laboratory model. The range of motion in the vertical direction was 183.3 cm2 for group 1, 181.9 cm2 for group 2, 182.9 cm2 for group 3, and 178.8 cm2 for group 4. The range of motion in the horizontal direction was 287.3 cm2 for group 1, 276.3 cm2 for group 2, 417.4 cm2 for group 3, and 405.2 cm2 for group 4. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 461-467DOI: (10.1016/j.jtcvs.2013.09.039) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions