Closed-Chest, Robotic Approach Speeds Recovery

Totally endoscopic coronary artery bypass (TECAB) surgery is a breakthrough approach to performing coronary bypass surgery.

Having performed more than 100 robotic TECAB procedures, the cardiac surgeons at the University of Chicago Medicine are highly skilled in endoscopic coronary artery bypass.

The goal of totally endoscopic coronary artery bypass surgery is the same as all coronary bypass procedures — to improve blood flow to the heart and to alleviate chest pain. The main difference is that instead of making a long incision through the breastbone, TECAB is performed through four to five fingertip-sized slits with the help of the da Vinci Surgical System.

What to Know About TECAB

The da Vinci robot is a highly sophisticated tool that enables the surgeon to perform the procedure with greater precision and control than is possible in traditional hands-on surgery. The surgeon sits in a console equipped with controls that direct robotic arms to perform the surgery. The robotic arms are very agile and work as an extension of the surgeon's hands. A tiny camera attached to the robotic arms gives the surgeon a very detailed, 3-D view of the operating space inside the chest.

The entire operation is performed as a closed-chest procedure. The heart continues to beat during the surgery and no heart-lung bypass machine is required. Internal mammary artery grafts are most frequently used, so grafts are rarely harvested from other parts of the body, such as the arm or leg.

Surgeons here use two internal mammary arteries for bypass grafts because these are among the "cleanest" and most durable vessels in the body. The mammary arteries of the average 80-year-old are usually plaque-free. The da Vinci robot makes it easier and safer for the surgeon to harvest these grafts. And because the breastbone is not split during a TECAB procedure, our surgeons are not concerned that the mammary arteries are put to a new use — circulation is maintained in the thoracic cavity.

For some patients, the best option requires both surgical and interventional cardiology procedures to improve blood flow to the heart. This approach is called a hybrid TECAB. A hybrid TECAB involves bypassing some blocked arteries using TECAB and opening other blocked vessels via angioplasty (which may include stent placement to prop open blocked arteries) performed by an interventional cardiologist. The cardiologist may perform the angioplasty at the same time as the TECAB or after the procedure. Hybrid TECAB is sometimes selected for patients with blockages located under the heart that are more difficult to access with the robot.

Totally endoscopic coronary artery bypass surgery offers many benefits for patients. Compared to traditional, open-heart bypass surgery, the advantages of TECAB include:

  • Faster recovery: Most patients are back to work and/or other activities within a week, compared to four to eight weeks with open-chest bypass.
  • No splitting of the breastbone: Keeping the breastbone intact speeds recovery and lessens the chance for post-surgical complications or infection.
  • Quicker resolution of pain: For many patients, Tylenol or aspirin are enough to control pain after discharge from the hospital.
  • Shorter hospital stay: The typical TECAB hospital stay is one to three days, versus five to seven for open-chest procedures.
  • Heart continues to beat during the procedure: Keeping the heart beating reduces risks for complications.
  • Elimination of the heart-lung bypass machine: Avoiding the bypass machine decreases the risks for neurological complications and stroke.
  • Minimal blood loss and less need for transfusion
  • Internal mammary artery grafts: These grafts are superior to vein grafts because they are better able to withstand blood pressure over time and are less likely to develop blockages, reducing the need for re-operation.
  • Minimal scarring: The procedure results in only four to five tiny scars, versus a long chest scar.

TECAB is a good option for people of any age who require coronary artery bypass surgery. For the elderly, TECAB avoids complications with weakened bones due to osteoporosis.

As with any surgery, the hospital stay and recovery times vary depending upon the overall health of the patient and other associated risk factors.

Currently, TECAB is an option for people who require up to two grafts, or four to five if the hybrid TECAB approach is used. In some cases, people who have had previous coronary bypass surgery can be candidates for TECAB. However, not everyone can have TECAB. The location of blocked arteries is one of the primary factors that affects which approach is selected.

TECAB is NOT an option in the following cases:

  • Patients who have had previous thoracic surgeries that have resulted in the lung being stuck against the chest wall
  • Patients with extremely unstable blood pressure, those in shock or those who just had a stroke
  • Extremely obese people
  • Patients presenting with an acute heart attack

Ultimately, many factors are taken into consideration when surgeons select the best coronary artery bypass surgery approach for each patient. Even if TECAB is not an option, our surgeons can offer other coronary bypass solutions that provide benefits over the traditional approach, such as off-pump beating-heart coronary artery bypass surgery.

TECAB is performed by fewer than 1 percent of all cardiac surgeons because it is a technically demanding procedure that involves specialized skills and training. This advanced technique requires that the entire surgical team — including nurses and other specialists — be experienced with this approach.

Our cardiac surgery team is led by a surgeon who has extensive experience in coronary anastomotic devices (miniature staplers that connect the arteries together) and has played a key role in the development of beating heart TECAB procedures. He has performed more than 600 robotic procedures and is a scientific thought leader in the area of robotically assisted cardiac surgery. This breadth of experience assures that people who come to UChicago Medicine for coronary bypass surgery benefit directly from the latest advances. All of our surgeons are dedicated to providing the best approach for each patient, and they continuously explore options for making the surgical experience better for patients.