Totally Endoscopic Coronary Artery Bypass

Another Form of Minimally Invasive Coronary Bypass Surgery

What is TECAB?

Totally endoscopic coronary artery bypass (TECAB) is the least invasive coronary artery bypass grafting operation. The bypass graft is placed through tiny holes without any opening of the chest. In comparison to coronary artery bypass grafting procedures, which are carried out through very small openings in the chest (MIDCAB), the operation is performed only through these small portholes. As a result, the surgical trauma and scarring for the patient are very minimal.

What happens during the operation?

The surgeon uses a surgical robot for the procedure, which enables the surgeon to perform complex surgical maneuvers inside the chest. The surgeon inserts a video camera, which is mounted on the operation robot, into the chest and uses two or three additional instruments on the robotic arms.

Robot-assisted minimally invasive surgery provides the benefits of traditional minimally invasive or laparoscopic surgery, but with important technological improvements, including:

  • Advanced optics that provide 10-times magnified, three-dimensional images of the surgical area.
  • Robotic arms that eliminate even the slightest human hand tremors, which allow for very precise surgical work.
  • Instruments with "wrists" that pivot 540 degrees, for greater maneuverability than is possible with human hands or laparoscopic instruments.

A very small incision is made in the groin for connection of the heart-lung machine. A sophisticated special heart-lung machine system is used for these operations. This system serves as a safety net for the patient and takes over the blood circulation while the heart is stopped for the bypass graft connection. The surgeon is working on vessels that are approximately 2 to 3 millimeters in diameter. A stopped heart and the robotic system ensure very accurate suturing of tiny bypass grafts.

After the bypass grafts have been placed and the heart-lung machine is removed, the surgeon and his team check the quality of the grafts by an angiographic exam, which is done while the patient is still under general anesthesia.

After the Operation

After the operation, the patient is transported to an intensive care unit for postoperative observation. The patient will be on a ventilator for several hours. The doctors watch carefully for adequate heart function. This requires monitors and lines connected to the body for several hours. Patients can drink, eat and walk around very quickly and are discharged home usually within four to five days after the operation.

Advantages

The minimally invasive TECAB procedure eliminates the need for a large (6-10 inch) incision made down the sternum (breastbone) to access the heart, which reduces a patient's surgical trauma. Other potential patient benefits include:

  • Less pain (and need for pain medication)
  • Less scarring
  • Shorter hospital stay
  • Quicker recovery and return to normal activities, and even light sports, within two to three weeks after the intervention
  • Less bleeding and need for blood transfusions
  • Lower risk of infection
  • The bypass grafts that are used can stay open and supply the heart with blood for a very long time. These so-called internal mammary arteries show durabiltiy rates in the 20- to 30-year range and are the best option for a patient with coronary artery disease.
  • No foreign material is implanted
  • Except for aspirin, which the patient with coronary artery disease has to take anyway, no blood-thinning medication is necessary

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This page was last updated: February 4, 2014

         
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