Robotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma.

Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma.

Tracking delays in report availability caused by incorrect exam status with Web-based issue tracking: a quality initiative.

Many radiology information systems (RIS) cannot accept a final report from a dictation reporting system before the exam has been completed in the RIS by a technologist. A radiologist can still render a report in a reporting system once images are available, but the RIS and ancillary systems may not get the results because of the study's uncompleted status. This delay in completing the study caused an alarming number of delayed reports and was undetected by conventional RIS reporting techniques. We developed a Web-based reporting tool to monitor uncompleted exams and automatically page section supervisors when a report was being delayed by its incomplete status in the RIS. Institutional Review Board exemption was obtained. At four imaging centers, a Python script was developed to poll the dictation system every 10 min for exams in five different modalities that were signed by the radiologist but could not be sent to the RIS. This script logged the exams into an existing Web-based tracking tool using PHP and a MySQL database. The script also text-paged the modality supervisor. The script logged the time at which the report was finally sent, and statistics were aggregated onto a separate Web-based reporting tool. Over a 1-year period, the average number of uncompleted exams per month and time to problem resolution decreased at every imaging center and in almost every imaging modality. Automated feedback provides a vital link in improving technologist performance and patient care without assigning a human resource to manage report queues.

Is there a role for robotic totally endoscopic coronary artery bypass in HIV positive patients?

BACKGROUND: Performing cardiac surgery on HIV positive patients represents a significant risk of occupational exposure to surgeons and their support staff. In addition, the immunocompromized state of these patients may be a factor which could adversely influence the results. Totally endoscopic coronary artery bypass grafting (TECAB) in HIV patients has not been reported. METHODS: A male patient with HIV and Hepatitis C presented with three vessel coronary artery disease requiring surgical revascularization. Totally endoscopic coronary artery bypass grafting was performed. Using the da Vinci surgical robot, the left and right internal mammary arteries were harvested and sutured to the second obtuse marginal branch and the left anterior descending artery respectively. RESULTS: The patient was discharged home on postoperative day six. At one month following the operation, the patient was asymptomatic and had returned to full activity without the need for sternal precautions. CONCLUSIONS: We describe the first case of completely endoscopic coronary surgery using the da Vinci system in an HIV patient. Double internal mammary artery grafting to the left coronary artery system was carried out successfully.