Learning curves and clinical analysis of robot-assisted coronary artery bypass grafting

Objective To investigate the characteristics of the learning curve of off-pump robot-assisted coronary artery bypass graft surgery(RACAB) and analysis the outcomes in the short and mid-term. Methods We performed a retrospective review of 72 patients with coronary artery disease(CAD) who underwent off-pump RACAB between May 2009 and May 2015. The patients were divided into 3 groups(group A, B and C) according to the operation sequence, 24 cases in each group. The operation time, blood loss, complications, ICU stays, hospital stays and follow-up results were analyzed, and the techniques skill and learning characteristics of RACAB were summarized. Results The preoperative data of three groups were similar except left ventricular end-diastolic diameter(LVEDD of group B was significantly lower than that of group C, P=0.033). Robot installation time, time of internal mammary artery harvesting, total operation time of group A were significantly longer than group B and C, and there was no significant difference between group B and C. Postoperative ICU stay in group C was significantly shorter than A and B(P=0.039), with no operative mortality in the three groups. There were no differences among the three groups of revascularization, recurrent angina symptoms, recurrent myocardial infarction and cerebral infarction(P>0.05). There were 2 patients died during the follow-up of the whole group, one for cardiac reason and one for non-cardiac reason. Conclusion The da Vinci RACAB achieved satisfactory recent and mid-term results in patients with simple multi-vessel CAD. A learning curve of about 20 cases is required to achieve adept operation. Key words: Surgical procedures, minimally invasive; Coronary artery bypass, off-pump; Robotics; Learning curve