Robotic Right Gastroepiploic Artery Harvesting

Abstract

Objective

Robotic surgery promises to extend the capabilities of the minimally invasive surgeon, and many surgical specialties are applying this new technology. However, there is no report of robotic harvesting of the right gastroepiploic artery (rGEA). We evaluated the possibility of video-endoscopic dissection of the rGEA using the da Vinci surgical system for use in minimally invasive coronary artery bypass surgery.

Methods

The procedure was performed on a porcine rGEA harvesting model using the Tuebingen MIS-Trainer and a pig model. In the pig model, a pneumoperitoneum (maximal pressure, 12 mm Hg) was established after the insertion of a 12-mm trocar (camera) using the open method. The surgical cart was positioned at the head of the pig. A 30-degree three-dimensional camera, using two parallel-arranged three-chip cameras, was inserted and mounted on the middle 12-mm trocar. Under direct visualization, the two lateral surgical arm trocars were then placed at both sides of the camera port. We mounted a permanent cautery hook and Cadiere forceps on the right and left surgical arm, respectively.

Results

We performed harvesting of the rGEA with the permanent cautery hook and Cadiere forceps mounted on the surgical arms. The rGEA were easily visualized and dissection with complete mobilization was achieved without injury in both models. The bleeding from the branch of the rGEA was prevented by use of the permanent cautery hook in the pig model.

Conclusions

We have preliminarily established, in pig, the feasibility of robotic rGEA harvesting without laparotomy, avoiding the risks of abdominal complications and expanding its use for all patients. However, further studies need to be undertaken to prove its practical feasibility in humans using the da Vinci surgical system to make it an effective operation.