Maryland Heart Center

Minimally Invasive Coronary Bypass Surgery

See totally endoscopic (no incision) minimally invasive coronary artery bypass (TECAB) surgical Webcast.

Dr. Bonatti performs rare robot-assisted triple bypass heart surgery. See Q&A, patient success story and news release.

View robotic heart surgery bypass interview with Dr. Johannes Bonatti.

Totally Endoscopic, Minimally Invasive Coronary Bypass Surgery (TECAB): High-Precision Robotic Surgery Without any Opening of the Chest

Patient after a TECAB operation
Postoperative day 9:

Postoperative day 10:

Four weeks after the operation:

The University of Maryland is one of very few centers worldwide offering the totally endoscopic (no incision) minimally invasive coronary artery bypass grafting (TECAB) procedure. Dr. Johannes Bonatti, professor of surgery at the University of Maryland School of Medicine, is director of the coronary surgery program.

Dr. Bonatti, recognized as one of the world's most experienced in minimally invasive coronary operations using the da Vinci robot, has performed more than 300 minimally invasive robotic heart surgeries, most of which were completely endoscopic (without an incision).

He leads the Maryland Heart Center team that performs the state-of-the-art TECAB procedure, which enables patients to recover much faster with fewer side effects compared to other minimally invasive coronary artery bypass operations and traditional operations with a large incision. (Read a patient success story.)

What is TECAB?
TECAB Procedure Video
After the Operation
Advantages
Whom do I Contact for More Information?

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 -- mini-thoracotomies -- (MIDCAB, SVST), the operation is performed only through these small portholes. As a result, the surgical trauma and scarring for the patient are very minimal.

The surgeon uses a surgical robot (da Vinci system) 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:

The da Vinci robot's "wristed" instruments provide a greater range of motion than the human hand while eliminating physician tremor.

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.

The bypass vessels are prepared inside the chest and no cutting of the leg or arms is necessary. 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.

TECAB Procedure Video

Watch Dr. Bonatti perform the TECAB procedure.

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

In the robot-assisted procedure, small incisions are made between the ribs, which helps to reduce pain, scarring, blood loss and the risk of infection.

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.

You can also learn more by reading about our patients' experiences.

Whom Do I Contact for More Information?

For more information or to schedule an appointment, please call 410-328-9169.

MAKE CORONARY SURGERY A FRIENDLY ACT
UNIVERSITY OF MARYLAND - CORONARY SURGERY TEAM

Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-800-492-5538 or 410-328-5842, physicians dial 410-328-6622 or 1-800-318-1019.