Background: The identification of the ideal anastomosis site and the proper port placement are critical for the success of closed-chest robotic surgery. We investigated a new systematic procedure for precise port placement for TECABs.
Methods: We used trigonometry and a human thoracic model to determine the optimal working angles between anastomotic plane, instruments, and endoscope. We then applied the results to seven human subjects as follows: 1. A navigation grid was located extrathoracically before cardiac MR examination. 2. The ideal anastomosis site was defined with the MR. Intrathoracic distances and angles were computed with cardiac MR software and projected onto the thorax. 3. The ideal port placement points were marked on the thorax.
Results: The optimal working angle between endoscope and instruments was 35 degrees. 0 degrees and 90 degrees angles were associated with a significant reduction in visualization, technical ease, quality and anastomosis time. The course of the LAD was identified in all seven volunteers with MR. Mean deviation of the endoscope port from the medioclavicular line was 4.3+/-2.1 cm and of the instrument ports from the anterior axillary line 8.4+/-2.4 cm.
Conclusions: Cardiac MR in combination with the navigation grid proved suitable for the visualization of coronary vessels for individually calculating port placement points on the thorax.