The impressive achievements associated with conventional coronary artery bypass grafting (CABG) surgery are largely attributable to an excellent surgical “platform” of factors that combine to facilitate precise anastomotic suturing—full ster-

Background: The current study reviews clinical feasibility experiences evaluating safety and efficacy of using robotic assistance to create a left internal mammary artery to left anterior descending artery (LIMA-to-LAD) anastomosis. Methods: Between August and November 1999, 9 patients (aged 54-73 years) underwent robotically assisted endoscopic coronary artery bypass grafting (E-CABG) after institutional review board approval and informed consent were obtained. The robotics were transthoracically introduced in the fifth and sixth intercostal spaces. The LIMA-to-LAD anastomoses were endoscopically constructed with robotic assistance, and patency was assessed by flow measurement. Results: Each anastomosis was performed robotically, without necessity for intraoperative intervention with traditional techniques. Robotic anastomosis times averaged 29.05 minutes. The robotic system added on average 41.28 minutes to the procedure. LIMA flows prior to anastomoses measured from 11.2 to 29.2 mL/min. LIMA flow measurements following anastomoses averaged 42.07 mL/min. There were no deaths or perioperative myocardial infarctions. Conclusions: Although E-CABG is an exhaustive and technically demanding procedure, it is feasible for a computerenhanced robotic telemanipulation system to safely and effectively provide substantial assistance to the surgeon completing a thoracoscopic coronary anastomosis.