Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report

Objective‍ ‍To summarize the clinical efficacy of robotic-assisted left thoracic small-incision minimally invasive direct coronary artery bypass grafting （MIDCAB）. Methods‍ ‍A retrospective analysis was conducted on the procedures and treatment outcomes of robotic-assisted MIDCAB in the Army Medical Center of PLA from October 2016 to June 2023. Baseline clinical information， MIDCAB-related data， perioperative conditions and data during follow-up were collected and analyzed. Results‍ ‍There were 23 patients subjected， including 21 males and 2 females， with a mean age of 58.17±7.49 years， and a body mass index （BMI） of 23.99±3.25 kg/m2. All of them experienced angina pectoris， and 1 had a history of myocardial infarction， 1 had dilated cardiomyopathy， 2 patients had chronic obstructive pulmonary disease （COPD）， and 10 had a history of percutaneous coronary intervention （PCI）. Robotic-assisted MIDCAB procedure was successfully completed. No internal mammary artery injury or transformation of the procedure occurred in these cases， and excellent bridging vessel flow was achieved after anastomosis of the internal mammary artery to left anterior descending branch. The incision length in the left chest was 8 （8， 8） cm， the operation time was 380 （300， 465） min， the intraoperative bleeding volume was 300 （100， 400） mL， the length of ICU stay was 3 （2， 3） d， the amount of thoracic drainage was 780 （525， 1 040） mL， and the postoperative length from surgery to discharge was 11.17±2.38 d. No mortality was observed during or within 30 d of hospitalization， and 1 patient was readmitted due to pericardial effusion within 30 d， and was discharged after symptomatic treatment including pericardiocentesis and drainage. No deaths， major adverse cardiovascular and cerebrovascular events （MACCE）， or re-revascularization occurred in all patients during outpatient and telephone follow-up. Conclusion‍ ‍Robotic-assisted internal mammary artery dissection is a delicate and safe technique， and coronary artery bypass grafting in minimally invasive small-incision off-pump is effective， safe and feasible， with satisfactory short- and mid-term outcomes. The technique is suitable for minimally invasive coronary artery disease surgery and is worthy of popularization and application.