39 A designated hybrid operative room will allow

performing a single-session procedure at one place without the need to transfer the patient from the operating room to the catheterization laboratory. ROBOTIC-ASSISTED CABG The surgical robot is an elegant microprocessor-controlled, electromechanical instrument that allows the surgeon to remotely manipulate fully articulating videoscopic instruments by way of master–slave servos and microprocessor control. These long, thin instruments, which can be inserted into the closed chest through half-inch incisions, are designed to allow multiple degrees of freedom and can precisely emulate Inhibitors,research,lifescience,medical the surgeon’s movements at the control console.40 A clear benefit to the robotic approach over other methods, however, has not been demonstrated. Since the introduction of surgical robotics in the 1990s, there has been a progressive increase Inhibitors,research,lifescience,medical in utilization for thoracic surgical procedures. Roxadustat mw Although mitral valve and

non-cardiac thoracic procedures account for the majority of cases, there are increasing reports of robotic-assisted coronary revascularization procedures. These reports include robotic LIMA harvest followed by a traditional MIDCAB41 or left thoracotomy off-pump CABG,45 totally endoscopic coronary artery bypass (TECAB) on the arrested heart,42,43 Inhibitors,research,lifescience,medical and totally Inhibitors,research,lifescience,medical endoscopic bypass without CPB (OP-TECAB).43 Although most TECABs and OP-TECABs involve only a LIMA–LAD graft, recent reports described a series of multivessel

revascularization procedures.42 These series have demonstrated that each of these methods of limited access off-pump coronary bypass is associated with a shorter hospital stay, less time on mechanical ventilation, fewer transfusions, and a more rapid return to full activity. Inhibitors,research,lifescience,medical The operative times are considerably longer than for open procedures, but improved time efficiency with experience is the norm. Also, questions related to graft patency and long-term results persist. Several earlier reports suggested a conversion to an open not procedure in > 50% of cases, but with increased experience conversion in the ≤10% range is more common.43 Because of the added expense and difficulty with learning the technique, the routine use of surgical robotics in CABG surgery does not seem likely in the near future. The robot has and will continue to evolve. Improved video resolution, lower-mass arms, the addition of a fourth tele-manipulator, and the availability of an elegant robotic coronary stabilizer will likely increase its effectiveness and extend its application. Refinement of automated distal anastomotic devices may further increase the growth of robotic coronary revascularization surgery.