Robotic Cardiac Surgery

The evolution of robotic-assisted cardiac surgery has been relentless ever since the first coronary and mitral valve procedures were performed in the late 1990s. Iterative advancements in technology have resulted in enhanced 3-dimensional stereoscopic visual systems, improved ergonomic instruments with greater flexibility, dexterity and multiple degrees of freedom of movement, programmable instrument carts with integrated energy sources, and the ability for the surgeon to continually hone their skills on a training simulator.

KEY POINTS

• One-half of all robotic cardiac cases are coronary artery bypass procedures, the remainder being comprised almost entirely of mitral valve and concomitant procedures.
  
• Minimally invasive direct coronary artery bypass (MIDCAB) is the most common robotic coronary procedure. The left internal mammary artery (LIMA) is harvested using the robotic instruments, followed by an off-pump LIMA-left anterior descending (LAD) anastomosis performed through a small left thoracotomy.
  
• MIDCAB can be used to treat isolated LAD stenosis, or it can be a component of hybrid coronary revascularization, coupled with percutaneous coronary intervention to diseased non-LAD targets in multivessel disease.
• Robotic total endoscopic coronary artery bypass is technically more challenging, although also has favorable results.
• The robot can be used for all types of mitral valve repair, irrespective of complexity. Valve replacement can be undertaken for those patients deemed not suitable for repair.