New endoscopic instrument kits allow atraumatic approach to coronary artery bypass procedures

Lisbon 19 September 2001At the annual meeting of the European Association for Cardio-Thoracic Surgery, Computer Motion Inc., specialised in medical robotics, has launched the innovative Endoscopic Atraumatic Coronary Artery Bypass (Endo-ACAB) procedure kits. Designed in co-operation with Thomas Vassiliades, M.D. at the Pensacola Heart Institute in Florida, these novel instruments have been used to enable the new minimally invasive Endo-ACAB procedure, which is performed on the beating heart through small incisions without the need to retract or lift the chest wall. Eliminating chest wall trauma greatly reduces post-operative pain and speeds recovery and return to normal activity.

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Despite the improvements of balloon angioplasty and stent therapies, studies have shown that a surgical graft of the Internal Mammary Artery (IMA) to the Left Anterior Descending (LAD) Artery, is the strongest predictor of long-term, event-free survival for patients with coronary artery disease. With the Endo-ACAB procedure, the IMA to LAD graft can be performed with minimal pain and trauma. Furthermore, this procedure can be applied to other regions of the heart in a similarly atraumatic manner.

In the Endo-ACAB procedure, the surgeon utilises Computer Motion's FDA-cleared AESOP Robotic System to harvest the left and/or right internal mammary arteries, for use as the conduit vessels, entirely through three 5-mm endoscopic ports. "This robotically assisted technique delivers a perfectly steady image and 10 to 15 times magnification", stated Dr. Vassiliades. "I am able to endoscopically harvest the full length of the IMA, significantly reducing the patient pain which would normally result from severe rib spreading during the vessel harvest", he added.

The bypass operation is completed by suturing the harvested mammary artery to the LAD artery through a tiny 4-cm incision parallel to the rib, thereby creating new blood flow around the blocked area in the heart. Patients are extubated in the operating room, awake and conversational in the Intensive Care Unit, and typically discharged within 48 hours. Dr. Vassiliades confirmed that these results are significant improvements as compared to a conventional bypass procedure. "The Computer Motion Endo-ACAB devices facilitate this new minimally invasive technique."

The company released a reusable instrument kit as well as a disposable procedure kit with a list price of $1200 to specifically address the requirements of this atraumatic approach to heart bypass surgery. "These instruments have been designed to allow the majority of the bypass procedure to be performed endoscopically", stated James Wright, vice president of Product and Procedure Development for Computer Motion. "Dr. Vassiliades' experience and insight was critical in the design and development of these new devices", Mr. Wright added.

To date, Dr. Vassiliades has performed more than 300 single vessel Endo-ACAB procedures and is optimistic that the technique is equally applicable to patients with multi-vessel disease. "Whether in connection with angioplasty in a hybrid procedure or treated surgically, this technique is applicable to patients with multi-vessel disease. I look forward to further developing the multi-vessel approach so that the procedure can be applied to a broader group of patients", the doctor commented.

Computer Motion is a high-tech medical device company evolving surgical practices to enhance patient lives. The company develops, manufactures, and markets proprietary computer-enhanced and robotic surgical systems, which enhance surgeons' capabilities, improve outcomes and reduce costs. Computer Motion plays a significant role in transitioning the surgical community from current open procedures to increasingly demanded endoscopic procedures.

Computer Motion's products include the AESOP Robotic Endoscope Positioner; the ZEUS Robotic Surgical System for new minimally invasive micro-surgical procedures, such as endoscopic beating heart bypass surgery; and the HERMES Control Center, a centralised system that enables the surgeon to voice control a network of "smart" medical devices. The AESOP Robotic Endoscope Positioner is the first FDA-cleared surgical robot, and the ZEUS Robotic Surgical System is CE-Marked for commercial sale in the European Community.

Computer Motion has completed an FDA-approved Phase 1 Investigational Device Exemption (IDE) coronary bypass study, and has initiated an IDE mitral valve surgery, general laparoscopic and thoracic studies with the ZEUS system. Also, the company has begun the second phase of its tubal reanastomosis study. You can read about Computer Motion's contribution to the first ever complete telesurgery procedure in this month's VMW article Surgeons perform successful near real time telesurgery from New York on patient in France.


Leslie Versweyveld

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