What is TECAB?

Totally Endoscopic Coronary Artery Bypass Surgery (TECAB) is a closed-chest, minimally invasive, entirely endoscopic robotic approach to treating coronary heart disease that results in faster recovery, shorter hospital stay and less risk for complications. It is an advanced form of Minimally Invasive Coronary Artery Bypass Surgery , which allows bypass surgery to be conducted off-pump (no heart-lung bypass machine is required) without opening the sternum (ribcage or breastbone).

As all other coronary bypass procedures , the goal of totally endoscopic coronary artery bypass surgery is to improve blood flow to the heart and to relieve the patient of chest pain. Instead of making a long incision through the breastbone as in the traditional hands-on bypass graft procedure, TECAB is performed through four to five tiny incisions with the help of the da Vinci Surgical System (also known as da Vinci tele-robotic Stereoscopic 3-D Imaging system) enabling the surgeon to perform the procedure with greater precision and control.

How is TECAB performed?

The system is comprised of a robotic "slave" system at the bedside. The surgeon performing the TECAB sits in a console equipped with controls that direct robotic arms to perform the surgery and work as an extension of the surgeon's hands. A tiny camera attached to the robotic arms gives the surgeon a very detailed, three-dimensional view of the chest cavity. The procedure frequently involves grafting of the internal mammary artery to the diseased coronary artery, and therefore does not require external harvesting of blood vessels.

What is a Hybrid TECAB

For some patients, both surgical and interventional cardiology procedures are required to improve blood flow to the heart resulting in an approach called a hybrid TECAB.

A hybrid TECAB involves bypassing some blocked arteries using TECAB, and opening other blocked vessels via angioplasty (which may include stent placement to prop open blocked arteries) performed by an interventional cardiologist. The cardiologist may perform the angioplasty at the same time as the TECAB or after the procedure. Hybrid TECAB is sometimes selected for patients with blockages located under the heart that are more difficult to access with the robot.

What are the benefits of TECAB?

Robot-assisted minimally invasive surgery provides the benefits of minimally invasive or laparoscopic surgery, but with important technological improvements. Compared to traditional, open-heart bypass surgery, the advantages of Totally Endoscopic Coronary Artery Bypass Surgery include:

•  Quicker recovery and return to normal activities. Most patients are back to work and/or other activities within a week, compared to four to eight weeks with open-chest bypass.

•  The breastbone is kept intact. 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, speeds recovery and lessens the chance for post-surgical complications or infection.

•  Less scarring. Because only tiny incisions are used, the resulting scarring is minimal as opposed to the long incision in case of open heart surgery.

•  Less pain. Can be managed with over the counter medicines like Tylenol or aspirin.

•  Shorter hospital stay. 1-3 days compared to 5-7 for open-chest surgery.

•  Elimination of the heart-lung bypass machine. Keeping the heart beating reduces risks for neurological complications and stroke.

•  Less bleeding and less need for blood transfusions

•  Internal mammary artery grafts. Being superior to vein grafts, the mammary artery grafts are better able to withstand blood pressure over time and are less likely to develop blockages, reducing the need for re-operation. Further, the bypass vessels are prepared inside the chest and no cutting of the leg or arms is necessary.

Who is a candidate for TECAB?

•  TECAB is a good option for people of any age who require coronary artery bypass surgery.

•  TECAB is an option for patients requiring up to three bypass grafts, or up to five if the hybrid TECAB approach is used.

•  In some cases, people who have had previous coronary bypass surgery can also take advantage of the TECAB.

•  The location of blocked arteries also plays a role in the selection of the TECAB procedure.

TECAB is NOT considered for patients who:

•  have had previous thoracic surgeries that resulted in the lung being stuck against the chest wall

•  have extremely unstable blood pressure, are in shock, or just had a stroke

•  are extremely obese

•  have an acute heart attack

When TECAB is not possible, other coronary bypass solutions that provide benefits over the traditional approach, such as off-pump beating-heart coronary artery bypass surgery can be offered.

Suggested reading

•  Overview of the heart and heart surgeries

•  Bios of US/UK trained heart surgeons practicing overseas

•  Internationally accredited hospitals offering affordable heart surgeries

•  Heart surgery patient testimonials

•  Medical tourism for cardiac procedures

•  Cost of Totally Endoscopic Coronary Artery Bypass (TECAB) Surgery in India