Robotic-assisted minimally invasive direct coronary artery bypass grafting in single vessel disease.

This video tutorial presents a case of robotic-assisted minimally invasive direct coronary artery bypass grafting in a patient who presented with stable angina and significant stenosis of the proximal left anterior descending artery.   The patient was intubated using a double lumen tube to allow for single lung ventilation, then positioned supine with the left chest slightly tilted up. Defibrillation pads were applied, and the patient draped. A small port incision was made in the left 3rd intercostal space for camera scope insertion; 2 further port incisions were made in the 5th and 7th intercostal spaces under direct vision. Three trocars were attached to the da Vinci Xi robot arms, and the left Internal mammary artery site was identified and then harvested robotically in a semi-skeletonised fashion (the thoracic fascia was dissected away while the concomitant veins were retained with the artery).  Heparin was then administered, and the pericardium was opened over the left anterior descending artery. Off-pump coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery was completed through a small left anterior thoracotomy. Hemostasis was achieved, and the incisions closed over one left pleural drain.