Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.

No abstract

This new robotic-enhanced surgical technique promotes an optimistic way of thinking about the further development of this procedure and its application in patients suffering from single-vessel CAD.

The introduction of robotic instrumentation has led to new minimally invasive surgical options in patients with coronary artery disease. [1][2][3][4] The application of an intrathoracic stabilizer enables closed-chest off-pump coronary artery bypass grafting (CABG) via a 4-point stab incision, avoiding sternotomy and minithoracotomy. We present a case of closed-chest off-pump CABG performed with wrist-enhanced robotic instrumentation in a patient with single-vessel coronary artery disease. The left internal thoracic artery (LITA) was used as the graft (operative day March 27, 2000).

Endoscopic surgery on the beating heart remains the ultimate goal for minimally invasive coronary artery surgery. The clinical outcomes and need for reintervention of the target vessel leave room for improvement and may be considered reflective of early experiences typically associated with dramatic departure from conventional therapy. Moving forward, advances in instrumentation and anastomotic technology seem to be essential for reproducible and reliable coronary anastomosis in a totally endoscopic approach.