Totally Endoscopic Coronary Artery Bypass (TECAB)

TECAB incisions. Click to enlarge.

The robot can be used to bypass blocked or narrowed coronary arteries.  Our favored approach is to use the robotic to perform the entire bypass procedure.  The TECAB operation involves only small incisions (7-15mm) and is totally endoscopic.  The internal mammary artery on the chest wall is detached from the chest and the anastomosis (the connection between the mammary artery to the blocked coronary artery to bring new blood to it) is done with the robotic instruments by the surgeon at the console.  We usually use suture for this exactly the same way that would be done with traditional approaches.  Due to the need for extensive training, experience, high-level teamwork, and major institutional support, the TECAB is performed by a relatively small number of surgical teams in the country.  We have all of the above at Weill Cornell Medicine/NewYork-Presbyterian Hospital.

Robotic Assisted Minimally Invasive Direct Coronary Artery Bypass (Robotic MIDCAB or ROBOCAB)

Typical incisions for robotic MIDCAB (minimally invasive direct coronary artery bypass) on the anterior and lateral left chest.

Incisions for robotic MIDCAB. Click to enlarge.

An alternative to the TECAB is a Robotic MIDCAB.  In this procedure, the robot is used to detach the internal mammary artery off the chest wall and make it available to use as a bypass.  A mini-thoracotomy is made on the anterior left chest under the breast and a standard handsewn connection is made, usually off-pump (without the heart-lung machine or stopping the heart or with the heart beating).  This is a much easier procedure than a TECAB and may be better for some patients with anatomy not ideal for TECAB.  Although the procedure usually is done for single vessel bypass, multivessel bypass can be performed or coronary stents used some vessels (hybrid approach, see below).

Hybrid TECAB/Robotic MIDCAB with Coronary Stenting

Our program now offers simultaneous Robotic TECAB or MIDCAB combined with stenting to other coronary arteries.  This is done in a hybrid operating room that has all the capabilities of a cath lab and of an operating room.  Most patients with coronary artery disease have multiple vessels involved.  My feeling is that minimally invasive bypass surgery is most applicable to performing one vessel bypass (left internal mammary artery to left anterior descending coronary artery-the main artery on the front of the heart).  This is the bypass graft with the best long term results which have been shown to be much more durable than stenting.  Although there are programs that do additional bypasses minimally invasively and robotically, I feel these procedures take too long with little added benefit in patients who are appropriate for stents to those other vessels.  Of course, this is just my opinion.  The fact that we offer both the robotic bypass and the stent at the same time on the same day is unique.   This approach also allows us to perform an angiogram on the surgical bypass graft to make sure it is working well.

Request an appointment online to discuss robotic heart surgery. If no appointments are available quickly enough for your needs, please contact my office at 215-955-6996

T. Sloane Guy, Robotic Heart Surgeon

T. Sloane Guy, MD

Dr. Guy earned his MD and completed surgery residency and cardiothoracic surgery fellowship at the University of Pennsylvania. He has extensive training and experience in robotic cardiac surgery. He is a former Lieutenant Colonel in U.S. Army who served 3 tours as a combat surgeon in Iraq and Afghanistan. He is Professor of Surgery and Director of Robotic & Minimally Invasive Cardiac Surgery at Sidney Kimmel Medical College at Thomas Jefferson University Hospital in Philadelphia.

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Contact Information

T. Sloane Guy, M.D.
Thomas Jefferson University Hospital, Division of Cardiac Surgery
111 South 11th Street, Suite 6210, Gibbon Building,
Philadelphia 19107
Phone: 215-955-6996
Fax: 215-955-6010
Email: sloane.guy@jefferson.com

T. Sloane Guy, MD is now director of Robotic & Minimally Invasive Cardiac Surgery at Jefferson Health.

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