Table 2.

Advantages and disadvantages of robotic and nonrobotic minimally invasive direct coronary artery bypass (MIDCAB)

Nonrobotic MIDCAB	Robotic MIDCAB
Involves a 5-6 cm thoracotomy	Involves a 3-4 cm thoracotomy or ports only—Cosmesis may be better
Rib spreading, especially during ITA harvest—Pain may be more	Minimal; no rib spreading
LITA harvest: Distal segment may be more difficult to take down	LITA harvest: Better visualization of the entire length of the LITA
View of the LAD: Adequate, if pericardium opened up to apex	View of the LAD: Limited, if using robot-assisted MIDCAB
LITA-LAD anastomosis: •Most commonly performed at the level of the incision •No facilitatory gadgets required	LITA-LAD anastomosis: •Most commonly performed at the level of the incision if guided by the camera •Facilitated by U-clips or distal anastomotic connectors, technically challenging in TE-CABG when hand-sewn.
Learning curve: Not as steep	Learning curve: Steep
Costs: Similar to conventional surgery	Costs: Higher due to disposables and initial cost of the robot itself
Additional aspects: •Very quick and efficient •Entirely dependent on the sewing skill of the surgeon •Can be discomforting for the surgeon •Difficult to teach due to restricted vision	Additional aspects: •Time consuming •Filtration of tremors •Comfortable for the surgeon •Better teaching capabilities due to visualization on a console

ITA, Internal thoracic artery; LITA, left internal thoracic artery; LAD, left anterior descending; TE-CABG, totally endoscopic coronary artery bypass grafting.