The Estech products enabled surgeons to access the heart through a minimal incision, a small puncture access port of less than 2 inches. Surgeons then isolated and controlled the artery on the surface of the heart, allowing the surgeon to attach a bypass graft without stopping the heart. Most patients were successfully discharged in only two to three days following surgery.
Art Bertolero, Estech's President and CEO, stated: "The use of our technology fulfills a five-year quest to offer patients the least invasive coronary artery bypass operation possible. With over 100 procedures completed at four different institutions, we believe there is great potential for ultra-small incision coronary artery surgery on a beating heart to become commonplace. This will result in far less pain and shorter recovery time for patients and also lower cost to the hospitals where surgeries are performed."
Dr. Michael Argenziano of New York Presbyterian Hospital has assisted in the development of the Estech procedure and was also instrumental in the development of a specialised surgical tool that enables the stabilisation of the patient's beating heart through a small puncture while keeping the ultra-small incision open for the surgeon to perform the bypass operation. Together with Dr. Mehmet Oz, Director, Cardiovascular Institute at New York Presbyterian Hospital, the surgeons have performed more than 20 successful ultra small incision coronary bypass operations since May 2003.
Dr. Argenziano commented: "This procedure gives patients the best of both worlds: a very small incision between the ribs, and a bypass operation on the beating heart, without the use of the heart-lung machine. Our patients are released from the hospital in just a few days with very small scars and excellent results. We are routinely using the patient's own artery from the chest wall to do the bypass, which we prepare using a surgical robot. Studies have shown that using the patient's own artery keeps the bypass open for much longer than any other technique."
The company has also worked with other pioneering surgeons in the United States and Europe. Ramzi Deeik, M.D. of Queen of the Valley Hospital at Napa Valley Medical Center in Napa, California, was the first surgeon in the San Francisco Bay Area to perform the Estech-style procedure, on an 86-year-old patient. Dr. Deeik used the Da Vinci Robot, developed by Intuitive Surgical Inc., to isolate the left internal mammary artery for use as a bypass graft through three 10-millimeter ports.
The Estech Access and Stabilisation Systems were inserted into another small incision, or "window", between the ribs, allowing Dr. Deeik to bypass a blockage in the left anterior descending (LAD) coronary artery without stopping the heart. Commenting on the procedure, Dr. Deeik stated: "Estech technology that allows surgeons to perform heart surgery on a beating heart through a two-inch incision provides great benefits to patients, reducing complications and recovery times."
Frank Van Praet, M.D. at O.L. Vrouw Ziekenjuis Clinic, Aalst, Belgium, commented: "We developed a very promising new procedure, a robotically-enhanced mini-thoracotomy for multi-vessel coronary bypass grafting on the beating heart. The new Estech Stabiliser System allowed me to work through an even smaller mini-thoracotomy than before since the stabiliser is introduced through the port made for the left robotic arm. It didn't obstruct the surgical access at all and offered an excellent stabilisation. Minimising the surgical access and avoiding retraction of the bony structures of the thorax offers the patient an optimal postoperative comfort level and recovery to complete rehabilitation."
Added Art Bertolero: "It is satisfying to continue to provide enabling technology that offers patients the least invasive alternatives. This ultra small incision procedure is what patients desire. The best news for these patients is that surgeons are using the patient's own artery off their chest wall to bypass the blocked artery rather than having to remove a vein from the patient's leg. Our mission is to make this a standard of care for the majority of patients. We are pleased to be working with physicians at both teaching and community hospitals to bring this advance to the medical community."
Founded in 1996, Estech is a recognised expert in Least Invasive Cardiac Surgery (LICS), offering a complete system of products for both beating heart and stopped heart surgical approaches. Estech products have been used in thousands of procedures throughout the United States, Europe and Asia-Pacific. More news is available in the VMW August 2002 article Closed chest surgery on beating heart performed at Cleveland Clinic with Estech MIS tools.