Axillary-coronary sequential vein graft for total endoscopic triple coronary artery bypass

We describe using an axillary-coronary vein graft for robotically assisted, total endoscopic coronary artery bypass grafting. After constructing the proximal vein anastomosis to the left axillary artery under direct vision, the graft was brought into the thorax through a thoracostomy in the second left intercostal space. Under cardiopulmonary bypass with cardioplegic arrest, the distal anastomoses were completed using da Vinci (Intuitive, Sunnyvale, CA) robotic instrumentation through small portholes. This procedure marks a significant advancement in robotic total endoscopic revascularization by increasing the range of targets available for the total endoscopic approach, thereby enlarging the patient population suitable for robotic revascularization.