Robotic-assisted coronary artery bypass on a beating heart: Initial experience and implications for the future

Background. Although totally endoscopic coronary artery bypass using facilitated anastomotic devices is still in development, practical less invasive surgical strategies using sophisticated robotic microsurgical systems have been applied to facilitate the journey to a completely endoscopic procedure. This report summarizes the initial clinical experience with off-pump coronary artery bypass grafting using the Intuitive da Vinci Surgical Robotic System. Methods. Robotically-assisted coronary artery bypass grafting through a small thoracotomy on a beating heart without the use of cardiopulmonary bypass was performed on 70 patients from February 16, 2004 through September 20, 2005. Postoperative morbidity, mortality, and length of stay were recorded. Results. Operative mortality was 0%. The average operative time per case for the entire series was 4 hours, 3 minutes. The average operative time per case for the first 10 cases was 5 hours, 56 minutes, which decreased to 3 hours, 52 minutes for the last 10 cases of the series. The incidents of postoperative complications were as follows: reoperations for bleeding ( 2 patients; 2.8%); transfusions ( 7 patients; 10%); atrial fibrillations ( 6 patients; 8.5%); infections ( 2 patients; 2.8%); neurologic ( 0%); renal failure ( 0%); and ventilation greater than 1 day ( 0%). The average postoperative length of stay was 5.7 days. Conclusions. Early results suggest robotic-assisted coronary artery bypass grafting is a safe and effective means of myocardial revascularization and its continued clinical use is justified. Operative time has decreased with experience. Robotic-assisted coronary artery bypass grafting performed through a small thoracotomy on a beating heart without the use of cardiopulmonary bypass may pave the way to a completely endoscopic, closed chest procedure for coronary artery bypass grafting.