**1. Introduction**

Rapidly developing technologies in the field of surgery have encouraged the shift of conventional techniques towards minimally invasive methods.

Since cardiovascular diseases are the leading cause of death worldwide, causing the greatest threat to public health, it is perfectly reasonable to implement practice with technological advancements to treat cardiovascular diseases with minimally invasive approaches [1].

Robotic-assisted surgery offers the clinical benefits of a minimally invasive approach as well as technical advantages such as enhanced precision and visualization.

Minimally invasive procedures employed in surgical coronary revascularization include Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB), Robotic-Assisted MIDCAB, and Totally Endoscopic Coronary Artery Bypass Grafting (TECAB). MIDCAB is a less invasive method of Coronary Artery Bypass Grafting (CABG), in which the surgical access is obtained by a left anterior

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 anastomosis.

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 additionally to badly constructed vascular status [2].

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.,
