Technical considerations in robotic internal thoracic artery harvesting: a series of clinical cases

Introduction: One of the main trends in modern cardiac surgery is the reduction of the invasiveness of surgical procedures. Robotic technologies enable a broad range of operations to be performed without sternotomy, thereby accelerating patient recovery andreducing the risk of postoperative complications. Objective: To describe the essential steps and technical considerationsof robot-assisted coronary artery bypass grafting (CABG) that ensure the convenience, safety, and reproducibility of this myocardial revascularization technique. Methods: The technique of robot-assisted CABG described in this article is based on experience with 50 minimally invasive CABG procedures performed using robotic technology in the Cardiac Surgery Department of University Clinical Hospital No. 1. Most patients were men – 47 (94%). The median age was 63 years [59–66], with the largestproportion of patients belonging to the 60–69-year age group (52%). The mean body mass index was 28.6 ± 5.6 kg/m². All procedures were performed electively, and no conversions were required. Results: All surgical procedures were completed successfully. In three cases, the internal thoracic artery (ITA) was injured during mobilization. At the current stage of our program, we have adopted a strategy of limiting the robotic stage to ITA harvesting without performing the distal anastomosis. The modular structure of the learning process for totally endoscopic coronary artery bypass grafting (TECAB) allowseach component of the procedure to be practiced sequentially. As our experience has accumulated, we have gradually expanded the scope of the intervention. Conclusion: Robot-assisted CABG, in which the ITA is harvested robotically and the anastomosis is constructed through a thoracotomy, provides a reliable foundation for mastering and subsequently implementing complete TECAB. It is important to recognize thatoutcomes improve as the surgical team gains relevant experience. Stepwise acquisition of robotic coronary surgery skills makes it possible to perform these procedures during the early stages of the learning curve without exposing patients to undue risk. Received 26 November 2025. Revised 15 April 2026. Accepted 5 May 2026. Informed consentThe patient’s informed consent to use the records for medical purposes is obtained. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. AcknowledgementsThe authors express their gratitude to Polina A. Kovaleva, an operating room nurse in the Department of MinimallyInvasive and Robotic Cardiovascular Surgery, University Clinical Hospital No. 1, Sechenov University, for her highlevel of professionalism and outstanding performance of her duties during high-technology surgical procedures.