TECAB on a DaVinci Xi platform Without an EndoWrist Stabilizer Combing the Technology of GelPOINT Mini, AirSeal, and Octopus Nuvo

G. Torregrossa¹, A. Yakobitis², M. Baudo^3
1Lankenau Heart Institute, Wynnewood, Pennsylvania ²Lankenau Medical Center, Wynnewood, Pennsylvania ³Lankenau Institute for Medical Research, Wynnewood, Pennsylvania

Please explain the educational or technical point that this video addresses.: Since the release of the Da Vinci Xi robotic platform in 2014, Intuitive has stopped producing the EndoWrist Robotic Stabilizer. This decision has severely limited the use of TECAB in contemporary practices because of the absence of a dedicated coronary stabilizer. The advancement of this procedure now depends on the emergence of a new robotic platform industry that will support robotic coronary surgery and offer a new robotic stabilizer. While awaiting such an announcement, we present an alternative, straightforward solution that integrates the technologies of GelPOINT Mini, AirSeal, and Octopus Nuvo.

Please provide a 250 word summary of the surgical video being submitted.: The GelPOINT Mini (Applied Medical, Santa Margarita, CA, USA) package includes a gel platform that attaches to the provided Alexis retractor (Applied Medical, Santa Margarita, CA, USA). In cases with smaller chest cavities, the Alexis XXS retractor can be modified to fit the GelPOINT Mini. Using the introducer and trochars, three punctures are made at the center of the gel membrane. The longest trochar is inserted first, followed by the two shorter trochars, all positioned close together centrally. Thereafter, the Octopus Nuvo (Medtronic Inc., Minneapolis, MN, USA), without its stabilizing tip, is inserted through the longest trochar, and only then it is secured in its final position. A pediatric-size enteral feeding tube is passed through the second trochar and trimmed at the tip and tied with silk to one arm of the stabilizer for saline circulation. Another silk is tied on the other arm to clip the LITA for exposure during the anastomosis. Two additional enteral tubes are prepared and inserted into the third trochar, trimmed at the tip and tied to the stabilizer. These tubes assist in flushing saline to help the surgeon visualize the target area. The stabilizer structure is inserted at the subxiphoid level and the working port with AirSeal technology (CONMED Corporation, Utica, NY, USA) is positioned at the 2nd intercostal space parasternally.