title: Challenges facing totally endoscopic robotic coronary artery bypass grafting.
abstract: BACKGROUND
  Robot-assisted surgery is growing in popularity; however, robotic totally endoscopic coronary artery surgery (TECAB) remains challenging, particularly in multi-vessel disease.
  
  
  METHODS
  A review of the current literature surrounding TECAB using the da Vinci® system.
  
  
  RESULTS
  The da Vinci robot is the only commercially available system, operating on a master-slave paradigm with the surgeon controlling the robotic arms from a remote console.
  
  
  CONCLUSIONS
  Robotic surgery today is presented with challenges, including dealing with a non-perfect robot without haptic control, a steep learning curve, lack of established training criteria and high cost. Strategies such as structured, simulated training and novel anastomotic devices may potentially shorten the learning curve, improve patency and facilitate grafting in multi-vessel disease. Future challenges will include the ability to demonstrate long-term patency, morbidity and mortality at least comparable to conventional CABG, whilst also offering cost effectiveness in this increasingly difficult economic environment.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Roberto
authors.initials: R
authors.lastname: Casula
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods / Q000639:trends; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D003324:Coronary Artery Disease / Q000601:surgery; D003365:Costs and Cost Analysis; D004502:Education, Medical, Continuing; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods / Q000639:trends; D006801:Humans; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D012371:Robotics / Q000191:economics / Q000193:education; D016896:Treatment Outcome
keywords: challenges; da Vinci® system; robotic-assisted coronary artery bypass grafting; totally endoscopic coronary artery bypass grafting