Computer-enhanced endoscopic coronary artery bypass grafting: the da Vinci experience

Anatomical and technical limitations as well as human factors render endoscopic coronary artery bypass surgery difficult. The da Vinci telemanipulator overcomes some of these shortcomings by restoring the dexterity and precision of a distant operator within the confined space in a closed-chest environment. Using the da Vinci system, total endoscopic coronary artery bypass grafting has evolved from a merely experimental surgical approach to a clinically applicable treatment option. Initially exclusively performed on the arrested heart, adjunct technologies such as endoscopic vacuum-assisted stabilizers now allow a single-vessel closed-chest beating heart procedure in selected patients. Despite the technical progress, endoscopic multivessel bypass grafting has yet to be achieved. The development of endoscopically applicable anastomotic devices and heart-positioning devices along with further refinements in telemanipulator technology, better optical systems, and image guided augmented reality scenarios may facilitate endoscopic bypass grafting in the future.