Robotic Totally Endoscopic Coronary Bypass using a Third-Generation Robot with the EndoWrist Stabilizer: Insights from 1,000 Consecutive Cases.

Objective

In robotic-assisted coronary surgery, few programs use the robot to execute the complete procedure (totally endoscopic coronary artery bypass [TECAB]). We report lessons learned from >1,000 consecutive TECAB cases at our institution.

Methods

Retrospective review of 1,035 patients undergoing robotic beating-heart TECAB (7/2013-3/2026) by a single experienced surgeon. Patients were divided chronologically into four groups of 250 cases each. Perioperative outcomes were compared across eras.

Results

In the whole cohort (n=1,035), the mean STS predicted risk of mortality was 1.43±2.1%. Multivessel TECAB was performed in 54% of patients, of whom 87% received BITA grafting. Of 1676 total anastomoses, 35% were via an anastomotic device; 63% via robotic suturing. There was 1 intraoperative conversion (0.09%). Mean LOS was 2.26±0.9 days. There was 1 clinical myocardial infarction and 3 strokes. Hospital mortality was 0.67% (O/E 0.47). Early graft patency was 97%. Across eras, STS PROM decreased (p=0.006). Multivessel TECAB declined (61% to 47%, p=0.02), while operative time increased (251 to 294 min, p=0.002), coinciding with transition to robotic suturing from anastomotic devices (98% to 0%, p<0.001) and increased trainee involvement. Conversion remained rare (1 early case). Hospital LOS shortened (2.7 to 2.0 days, p<0.001); POAF decreased (18 to 8%, p=0.002). Early mortality and MACCE remained low with no temporal difference (p=0.384 and p=0.484, respectively). Among HCR patients, graft patency remained >96% across all eras (p=0.35).

Conclusions

In this series of 1,035 robotic beating-heart TECAB patients using the third-generation robot with an EndoWrist stabilizer, we demonstrate that the procedure can be performed with consistent, excellent results. These findings support the sustainability of TECAB with the evolution of new robotic systems with EndoWrist stabilization.