OBJECTIVETo summary the first 14 cases undergoing internal mammary artery (IMA) harvest using da Vinci S system and minimally invasive direct coronary artery bypass grafting (MIDCAB) on beating heart.

METHODSThe average age of patients was (60.4 +/- 10.1) years old. One case was female and 13 male. All the patients had a history of angina. The coronary angiography showed severe stenosis of anterior descending branch in all patients, of which 2 cases had diagonal and circumflex branch stenosis. Four case had myocardial infraction history. All the patients had good lung function and had no medical history of pleurisy. Without sternotomy, the camera cannula was placed in the left, 3 cm lateral to nipple in the 4th intercostal space (ICS). Da Vinci instrument arms were inserted through two 1 cm trocar incisions. The right instrument generally was positioned 4 to 6 cm cephalad to camera cannula in the 2nd or 3rd ICS. The left instrument arm was positioned 4 to 6 cm caudal to the camera cannula in the 5th or 6th ICS. Arm trocar sites were maintained 6 cm apart at chest entry. The internal mammary artery was harvested in routine methods. Thirteen cases underwent left internal mammary artery harvest, one case underwent right internal mammary artery harvest, one case underwent double internal mammary harvest. MIDCAB was performed on beating heart in 14 cases and 1 case accepted the totally endoscopic coronary artery bypass (TECAB).

RESULTSAll cases were accomplished successfully without complications. The average time of ICU was 20 hours. Robotic surgery had less draining than the conventional coronary bypass.

CONCLUSIONSTotally robotic internal mammary artery harvest and beating heart coronary artery bypass is less invasive, more precise, safe and efficient.