Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting

This article is part of CTSNet’s Guest Editor Series, “Robotic-Assisted Coronary Artery Bypass Graft Surgery—Techniques and Procedures” Dr. M. M. Yusuf brought together cardiac surgery experts from around the world to contribute procedure videos on various techniques.

Robotic-assisted minimally invasive direct coronary artery bypass (robotic-assisted MIDCAB) is a minimally invasive surgical approach for treating coronary artery disease. To begin, three ports are placed in the left hemithorax, and the camera is placed in the mid-port, followed by working arms on either side under camera guidance. The magnified 3D view provided by the robot allows the surgeon to work within a smaller surgical field, thus enhancing precision and potentially minimizing complications. The surgeon used the robotic arms to carefully harvest the left internal mammary artery (LIMA), which is the preferred conduit due to its long-term durability. The LIMA is then anastomosed to the left anterior descending artery under direct vision on a beating heart through a very small thoracotomy incision without rib retraction. This minimally invasive approach offers potential benefits such as less pain, faster recovery time, and a smaller scar compared to traditional open-heart surgery. Robotic-assisted MIDCAB is safe, and the benefits include minimal morbidity and blood loss, reasonable ventilation time, and shorter intensive care unit and hospital stays. 

References

1. Nesher N, Bakir I, Casselman F, et al. Robotically enhanced minimally invasive direct coronary artery bypass surgery: a winning strategy?. J Cardiovasc Surg (Torino). 2007;48(3):333-338.
2. Roubelakis A, Casselman F, van der Merwe J, Stockman B, Degrieck I, Van Praet F. Robotic-enhanced coronary surgery in octogenarians. Interact Cardiovasc Thorac Surg. 2017;24(3):384-387. doi:10.1093/icvts/ivw369.

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