Robotic totally endoscopic coronary artery bypass grafting—port placements, internal mammary artery harvesting and anastomosis techniques

Abstract

Coronary artery surgery has evolved substantially over the past several decades. Many of these enhancements have offered patients improvements in graft patency and have decreased the morbidity of coronary surgery. Robotic totally endoscopic coronary artery bypass (TECAB) grafting is a procedure in which all main operative steps including anastomotic suturing are carried out by surgeons using a surgical robot through endoscopic port site incisions. The procedure can be performed as a standalone operation with multiple arterial grafts or as part of hybrid coronary interventions with cardiology colleagues. In the hybrid approach, patients will undergo TECAB and then have percutaneous coronary intervention with placement of drug eluting stents performed during the same hospitalization. Robotic TECAB is a versatile procedure that provides patients the benefits of quicker recovery with enhanced quality of life and no sternal precautions. Although there is a learning curve, TECAB is an important procedure to master that cardiac surgeons who are looking towards the future of our specialty should have available in their armamentarium to address coronary disease. In this technical article, we present the detailed preparation and technical conduct of the TECAB grafting in its arrested heart version using peripheral cardiopulmonary bypass and cardioplegia through an endoaortic balloon catheter. We also explore patient selection, clinical advantages, procedural challenges, and expert operator guidance for avoiding complications.