Robotic-assisted, minimally invasive direct coronary artery bypass-preparation, conduit harvest and execution.

Robotic-assisted, minimally invasive direct coronary artery bypass is a surgical technique that involves robotic-assisted harvest of the left internal mammary artery, small left-anterior thoracotomy and minimally invasive, off-pump, direct left internal mammary artery to left anterior descending artery anastomosis. It is indicated in the setting of proximal or diffuse single-vessel left anterior descending artery disease, chronic total occlusion of the left anterior descending artery or a hybrid approach to revascularization in combination with percutaneous treatment of other lesions. Benefits include avoidance of sternotomy and rapid recovery, particularly in medically complex patients, while achieving the survival benefit associated with a left internal mammary artery-left anterior descending artery anastomosis. Although there is an initial learning curve for surgeons, an understanding of positioning and exposure techniques can minimize early challenges. We present a step-by-step video tutorial of robotic-assisted, minimally invasive direct coronary artery bypass, including patient positioning, robotic port orientation, analgesic and local anaesthetic strategies, conduit harvest and anastomotic technique.