**3.2 Technical advantages**

*Latest Developments in Medical Robotics Systems*

additionally to badly constructed vascular status [2].

**2. History of robotic cardiac surgery**

anastomosis.

applications.

**3. Advantages**

**3.1 Clinical advantages**

tive hospital stay [9, 10].

mini-thoracotomy, instead of a conventional sternotomy. In robotic-assisted MIDCAB, the left internal thoracic artery (LITA) harvest is performed with the robotic platform and is then followed by a direct anastomosis sewn through a small thoracotomy incision. Finally, TECAB is the entirely endoscopic version of the procedure, in which the robotic platform is used for both graft harvesting and coronary

Robotic MIDCAB and TECAB can both be done either on beating heart or on arrested heart, with the aid of cardiopulmonary bypass (CPB) support or not. Whether the operation is conducted on a beating or arrested heart is decided cautiously, considering the vascular status of the patient since the arrested heart approach may provide a better quality of anastomosis. Not only is CPB obligatory on the arrested heart approach, but it also comes in handy on a beating heart approach in patients with poor blood gas exchange, or with multiple vessel disease

In this chapter, we discuss the currently available robotic-assisted CABG strategies, including Robotic-Assisted MIDCAB, robotic TECAB with the aid of cardiopulmonary bypass (CPB), either on a beating or arrested heart, as well as robotic TECAB without the aid of CPB to achieve single or multivessel coronary grafting performed either with the robotic anastomotic device or in a hand-sewn fashion.,

The use of robotic assistance in surgical procedures dates back to 1985, when Kwoh et al. used a robotic system to improve the accuracy of CT-guided brain tumor biopsies [3]. Davies et al. later used robotic techniques for transurethral resection of the prostate in 1991 [4]. Peaked interest in robotic applications in surgery led to the development of new robotic systems. In 1996, Carpentier et al. conducted the first robot-assisted cardiac procedure, which was a mitral valve repair [5]. In 1999, Mohr et al. [6] and Loulmet et al. [7] performed CABG with the aid of a robotic platform. Over time, robotic-assisted CABG procedures evolved from single-vessel to multi-vessel, and its use has since then expanded to the integration with hybrid

The shift of conventional procedures towards minimally invasive approaches has allowed patients to benefit from surgical treatment with fewer postoperative complications, reduced morbidity associated with surgical trauma, and shorter length of stay while enhancing the postoperative quality of life and cosmetic outcomes [8]. Robotic-assisted MIDCAB offers a minimally invasive alternative to the traumatic median sternotomy performed in conventional CABG by providing access to the thoracic cavity through a less traumatic left anterior mini-thoracotomy. This approach reduces postoperative pain scores, and also eliminates the usual risk of poor healing following median sternotomy, thus reducing the length of postopera-

Sternotomy prolongs the recovery duration and bears the risk of poor healing and deep sternal wound infection (DSWI). Despite the fact that DSWI has a low incidence (between 0.2% and 3%), it is a deadly complication, and it weighs a heavy burden on healthcare with the need of repeated surgical interventions,

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Robotic-assisted minimally invasive procedures have enabled surgeons to perform surgical procedures with enhanced vision, precision, control, and dexterity [25]. Although the lack of haptic feedback was initially observed as a limitation for robotic surgeons, the Da Vinci system provides outstanding 3D visualization to observe the displacement of tissues which compensates for the lack of tactile feedback [26]. In addition to greatly improved visualization, robotic instrumentation also provides several technical advantages. Built-in motion scaling converts large natural movements to ultraprecise micromovements, and tremor filtration allows smoother and more precise motions of the articulating instrument at the surgical site [27, 28]. The wristed robotic instrumentation and robotic arms provide seven degrees of freedom (three for translation, three for rotation, and one for grasping), rather than only four degrees of movement maintained by the endoscopic devices [29]. Furthermore, robotic-assisted surgery eliminates the "fulcrum effect", otherwise faced by long-shafted endoscopic instruments, in which the hand of the surgeon and the tip of the instrument moves in opposite directions [30].
