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Tecab On The Da Vinci Xi Platform Without Endowrist Stabilizer: First 50 Cases From A Single-center Experience
Massimo Baudo
1, Francesco Cabrucci
1, Yoshiyuki Yamashita
2,
Amanda Yakobitis2, Courtney Murray
2, Gianluca Torregrossa
2.
1Lankenau Institute for Medical Research, Wynnewood, PA, USA,
2Lankenau Medical Center, Wynnewood, PA, USA.
OBJECTIVE: We report our initial experience performing totally endoscopic coronary artery bypass (TECAB) using the Da Vinci Xi platform without an EndoWrist stabilizer, utilizing a combination of GelPOINT Mini, AirSeal, and the Medtronic Nuvo.
METHODS: The procedure begins with the GelPOINT Mini kit, using an Alexis retractor to establish the access platform. Three trochars are inserted into the gel membrane to accommodate the Medtronic Nuvo device, a pediatric feeding tube, and two additional enteral tubes for saline flushing. An AirSeal trochar maintains stable pneumopericardium. After docking the robotic arms, the left internal thoracic artery (LITA) is harvested and connected to the Nuvo. All consecutive patients undergoing TECAB were included during the period from January 2024 to June 2025 from our center. The primary endpoint was to evaluate early mortality. Secondary endpoints consisted in postoperative complications.
RESULTS: During the study period, 51 patients underwent TECAB. The mean age was 62.0 ± 10.9 years, with 80.4% (41/51) being male. The median BMI was 28.8 [25.95, 32.70] kg/m². The mean left ventricular ejection fraction was 60.0% ± 7.5%, and the mean HbA1c was 6.13 ± 1.64. The median STS predicted mortality score was 0.50 [0.32, 0.88]. Four patients (7.8%) underwent concomitant left atrial appendage occlusion. Intraoperatively, the median LITA-LAD flow was 50.0 [43.0, 65.0] mL/min. Twenty-one patients (41.2%) underwent TECAB as part of a hybrid revascularization strategy, including 3 cases (5.9%) of reverse hybrid revascularization. The majority (n=32, 62.7%) were extubated in the operating room. There were no conversions to sternotomy, but one patient required reoperation for bleeding. Postoperatively, there were no strokes, myocardial infarctions, or deaths. The median hospital length of stay was 2.0 [1.0, 2.0] days, and 98% (50/51) of patients were discharged directly home. At 30-day follow-up, there were no readmissions or mortality.
CONCLUSIONS: In appropriately selected patients, TECAB represents a valuable option for coronary revascularization. Previous studies have also confirmed its safety and effectiveness, reporting excellent clinical outcomes. Moreover, it is associated with shorter hospital stays compared to procedures involving sternotomy or thoracotomy.
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