Endoscopic Coronary Artery Bypass Surgery

Coronary artery bypass graft (CABG) surgery is a major heart operation performed on more than a half-million people each year. Typically, the recovery time is four to eight weeks after surgery. However, less invasive techniques, which are offered by Washington University heart surgeons, are changing the face of this type of surgery.

CABG uses blood vessels from the patient’s chest or leg to go around or “bypass” clogged coronary (heart) arteries. One end of a vessel is attached to the aorta (the large artery that carries blood from the heart), and the other end is attached to the coronary artery below the point at which it’s blocked. The new channel allows blood to flow to the heart.

Traditional CABG surgery requires a large incision dividing the breastbone and use of the heart-lung machine. In the less invasive technique, a physician inserts an endoscopic camera and surgical instruments through quarter-inch openings in the patient’s skin. The surgeon sits at a computer console that displays the surgical field and holds handles that look just like regular surgical instruments. The surgeon's delicate motions are mechanically relayed to a computer control system that is known as the robot.

The surgeon’s movement is digitized, and the digital information is then filtered to remove all tremors. This information is used to control two robotic arms attached to the operating room table. These arms hold the surgical instruments that enter the patient through the quarter-inch ports.

Benefits of minimally invasive CABG may include less postoperative pain, a shorter hospital stay and a shorter recovery period. Currently, this endoscopic surgery is available only for patients who need a single bypass (one artery to repair). However, within a few years, the technique may be available to other heart patients.

Ralph J. Damiano, MD, chief of cardiac surgery, was the first surgeon to perform endoscopic bypass surgery in North America.

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