title: Robotic technology-probably a safe tool for development of completely endoscopic coronary revascularization procedures.
abstract: BACKGROUND
  : Totally endoscopic coronary artery bypass grafting (TECAB) requires telemanipulation technologies because attempts using conventional thoracoscopic instrumentation have completely failed. These complex operations require individual and team learning curves and necessitate a stepwise approach. The aim of this study is to assess risk adjusted outcome in robotically assisted coronary artery bypass grafting (CABG) after the first 6 years of application.
  
  
  METHODS
  : From 2001 to 2007, 177 CABG procedures were performed using the da Vinci system. A low risk patient population [age 59 (31-76) years, EuroSCORE 1 (0-7)] was treated. The following procedures were carried out: endoscopic internal mammary artery takedown in minimally invasive direct coronary artery bypass, Off-pump coronary artery bypass, and CABG (n = 26); robotic suturing of left internal mammary artery to left anterior descending artery anastomoses through sternotomy (n = 32); TECAB on the arrested heart (n = 108); TECAB on the beating heart (n = 11).
  
  
  RESULTS
  : There was no hospital mortality, and cumulative risk adjusted mortality plots showed that 2.76 predicted events did not occur. Given 177 event free procedures Clopper Pearson estimations revealed a 95% confidence interval between 0.0% and 2.3% for perioperative mortality.
  
  
  CONCLUSIONS
  : Introduction of robotic TECAB grafting appears to meet current CABG safety standards. Initial application in low risk patients and a stepwise approach towards completely endoscopic versions of the operation are worthwhile. Despite a high grade of innovation and despite learning curves, perioperative mortality may be lower than predicted.
authors.affiliation: From the Departments of Cardiac Surgery and Cardiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rützler
authors.forename: Felix
authors.initials: F
authors.lastname: Weidinger
authors.forename: Roland
authors.initials: R
authors.lastname: Schistek
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer