**3. Advantages**

#### **3.1 Clinical advantages**

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 postoperative hospital stay [9, 10].

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,

**79**

*Robotic Coronary Artery Bypass Grafting: History, Current Technique, and Future Perspectives*

prolonged length of stay, lower quality of life after CABG surgery, with higher costs [11–13]. Patients with comorbidities such as diabetes mellitus, chronic obstructive pulmonary disease, obesity, peripheral vascular disease have an increased risks of DSWI [14–17] Also, female sex, older age, bilateral internal thoracic artery takedown are independent risk factors on that matter [16–19]. Thanks to its minimally invasive properties, TECAB surgery reduces the risk of DSWI even in BITA take-

The postoperative overall quality of life is improved in both robotic-assisted

In terms of outcomes, robotic-assisted CABG graft patency rates were found to be equivalent to outcomes of the conventional technique [23]. TECAB has yielded

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

As CABG surgery is the most commonly performed and adult cardiac surgery procedure worldwide, there has been a growing interest in robotic-assisted CABG. However, despite the initial enthusiasm, it did not become as widespread as

expected, for reasons such as its steep learning curve, the requirement of an experi-

Each patient should be individually assessed by a multidisciplinary team of cardiac surgeons and cardiologists to determine the best approach regarding myocardial revascularization. Clinical status, associated comorbidities, and anatomical features should be considered when determining the appropriate strategy

CABG and conventional CABG, thanks to enhanced myocardial perfusion obtained by coronary revascularization. Nevertheless, while patients undergoing TECAB achieve this rather rapidly, those undergoing conventional CABG reach the same level of comfort much later due to the greater invasive nature of the

excellent results, even in patients with a high risk of mortality [24].

*DOI: http://dx.doi.org/10.5772/intechopen.99399*

down surgery [14, 20, 21].

**3.2 Technical advantages**

sternotomy [22].

directions [30].

**4. Disadvantages**

**5. Patient selection**

for myocardial revascularization.

enced surgical team, and its higher costs [31].

*Robotic Coronary Artery Bypass Grafting: History, Current Technique, and Future Perspectives DOI: http://dx.doi.org/10.5772/intechopen.99399*

prolonged length of stay, lower quality of life after CABG surgery, with higher costs [11–13]. Patients with comorbidities such as diabetes mellitus, chronic obstructive pulmonary disease, obesity, peripheral vascular disease have an increased risks of DSWI [14–17] Also, female sex, older age, bilateral internal thoracic artery takedown are independent risk factors on that matter [16–19]. Thanks to its minimally invasive properties, TECAB surgery reduces the risk of DSWI even in BITA takedown surgery [14, 20, 21].

The postoperative overall quality of life is improved in both robotic-assisted CABG and conventional CABG, thanks to enhanced myocardial perfusion obtained by coronary revascularization. Nevertheless, while patients undergoing TECAB achieve this rather rapidly, those undergoing conventional CABG reach the same level of comfort much later due to the greater invasive nature of the sternotomy [22].

In terms of outcomes, robotic-assisted CABG graft patency rates were found to be equivalent to outcomes of the conventional technique [23]. TECAB has yielded excellent results, even in patients with a high risk of mortality [24].
