Historical landmarks in the development of robotic coronary bypass grafting.

Robotic technology was first used in history for the minimally invasive surgical treatment of coronary artery disease. In 1998, the first operations were carried out at the Hôpital Broussais in Paris. Thereafter, several European and United States (US) centers developed surgical concepts for robotically assisted internal mammary artery harvesting and the construction of the anastomoses, either through minithoracotomy or in a totally endoscopic fashion. Initial experiences were documented in a number of single and multicenter series published in the early and mid-2000s. Key steps in further procedure development included the introduction of a robotic endostabilizer for beating heart completely endoscopic operations, the combination with percutaneous coronary intervention in hybrid approaches, the introduction of second, third, and fourth generations of surgical robots with improvements in each iteration, the availability of anastomotic devices, and most recently, the emergence of new robotic technology companies producing interesting alternatives to the existing machines. The larger clinical series included 500 to over 1,000 patients, with clinical results that well justified the continued application of robotics. Development of robotic coronary bypass grafting has generally been slow, but at committed centers, the procedures are routine, reproducible, safe, and effective. Over 25 years of development, robotic surgical coronary revascularization has become an important component in the armamentarium of minimally invasive heart surgery.