Robotic minimally invasive direct coronary artery bypass (MIDCAB): a standardised operative technique

Minimally invasive direct coronary artery bypass (MIDCAB) enables left internal mammary artery (LIMA) to left anterior descending artery (LAD) revascularisation without sternotomy or cardiopulmonary bypass. Robotic-assisted LIMA harvest improves visualisation and maximises conduit length while preserving the benefits of minimal access surgery. We describe a standardized technique for off-pump robotic-assisted MIDCAB (LIMA- LAD) developed in an experienced robotic coronary program, including operative setup, technical execution, postoperative care, and key considerations that allow reproducible outcomes.