Related Experiment Video
Updated: Sep 9, 2026
Application of End-to-end Anastomosis in Robotic Central Pancreatectomy
Published on: June 2, 2018
Robotic totally endoscopic coronary bypass using a third-generation robot with the EndoWrist stabilizer: Insights
Sarah Nisivaco1, Hiroto Kitahara1, Yazan Al-Jamal1
1Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill.
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 >1000 consecutive TECAB cases at our institution.
Methods:
In a retrospective review of 1035 patients undergoing robotic beating-heart TECAB (July 2013 to March 2026) by a single experienced surgeon, patients were divided chronologically into 4 groups of 250 cases each. Perioperative outcomes were compared across eras.
Results:
In the whole cohort (n = 1035), the mean Society of Thoracic Surgeons Predicted Risk of Mortality was 1.43 ± 2.1%. Multivessel TECAB was performed in 54% of patients, of whom 87% received bilateral internal thoracic artery grafting. Of 1676 total anastomoses, 35% were via an anastomotic device; 63% via robotic suturing. There was 1 intraoperative conversion (0.09%). Mean length of stay was 2.26 ± 0.9 days. There was 1 clinical myocardial infarction and 3 strokes. Hospital mortality was 0.67% (observed/expected 0.47). Early graft patency was 97%. Across eras, Society of Thoracic Surgeons Predicted Risk of Mortality scores decreased (P = .006). Multivessel TECAB declined (61% to 47%, P = .02), whereas operative time increased (251 to 294 minutes, P = .002), coinciding with transition to robotic suturing from anastomotic devices (98% to 0%, P < .001) and increased trainee involvement. Conversion remained rare (1 early case). Hospital length of stay shortened (2.7 to 2.0 days, P < .001); postoperative atrial fibrillation decreased (18 to 8%, P = .002). Early mortality and major adverse cardiac and cerebrovascular events remained low with no temporal difference (P = .384 and P = .484, respectively). Among patients who underwent hybrid coronary revascularization, graft patency remained >96% across all eras (P = .35).
Conclusions:
In this series of 1035 patients who underwent robotic beating-heart TECAB via 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.
