Minimally invasive surgical coronary artery bypass in women

Figures

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  Figure 1. Location of robotic ports for LIMA harvest: superior port (“right hand”), camera port, and a third port (“left hand”). LIMA, left internal mammary artery.

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  Figure 2. Key landmarks for robotic LIMA harvest, including left subclavian artery, LIMA, left internal mammary vein, and phrenic nerve. LIMA, left internal mammary artery.

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  Figure 3. Robotic LIMA harvest. (A) Endothoracic fascia incised 1 cm lateral to the LIMA to begin robotic harvest. (B) Sweeping motion to mobilize endothoracic fascia off the LIMA pedicle. LIMA, left internal mammary artery.

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  Figure 4. Needle insertion through the chest wall to correlate anterior thoracotomy skin incision with intrathoracic location of the LAD. LAD, left anterior descending.

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  Figure 5. Direct visualization of the heart and LAD through anterior thoracotomy incision to perform LIMA-LAD anastomosis. LIMA, left internal mammary artery; LAD, left anterior descending.

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  Figure 6. Anterior thoracotomy skin incision offset 0.5–1 cm superior to inframammary line and into the breast, enabling creation of a breast flap for entry into the thoracic cavity.

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  Figure 7. Placement of tissue stabilizer device on LAD via a subcostal incision with tunnelling through the diaphragm into the thoracic cavity. LAD, left anterior descending.

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  Figure 8. LAD occluded using silastic retractor tape with the presence of an intracoronary shunt. LAD, left anterior descending.

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  Figure 9. Hand-sewn LIMA to LAD anastomosis performed in a standard fashion. LIMA, left internal mammary artery; LAD, left anterior descending.

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  Figure 10. Lung re-inflated under direct visualization to ensure LIMA graft position is maintained. LIMA, left internal mammary artery.