If you ask, can coronary bypass surgery be performed without opening the chest? Yes, using a totally endoscopic coronary artery bypass (TECAB) technique, but in selected patients.
TECAB is a robotic-assisted, minimally invasive form of coronary artery bypass grafting (CABG) that allows surgeons to create bypass grafts through a few small chest incisions with the assistance of a surgical robot. Unlike conventional CABG, TECAB does not require the breastbone (sternum) to be divided.
The goal remains the same: restore blood flow to the heart when coronary arteries are significantly narrowed or blocked. What changes is the way the surgeon reaches the heart. Instead of making a long incision through the breastbone, TECAB is performed through 4 to 5 fingertip-sized slits with the help of the da Vinci Surgical System.
However, not everyone is eligible for TECAB. The final decision on whether the procedure is suitable for you will depend on the location and extent of blockages, heart function, lung function, prior chest surgery or adhesions, body habitus, and overall clinical stability.
Read Also: Robotic vs. Open-Heart Surgery: What Patients Need to Know
What Is Robotic Bypass Surgery (TECAB)?
Robotic coronary bypass is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. This robotic-assisted procedure is performed without opening the chest, meaning it uses the assistance of a robot to help the surgeon manoeuvre inside the thorax.
TECAB stands for Totally Endoscopic Coronary Artery Bypass. “Totally endoscopic” means the bypass is performed via small ports rather than through a traditional chest-opening incision.
During TECAB surgery, the surgeon may use internal mammary arteries as grafts to create a new route for blood to reach the heart muscle beyond the blockage.
Traditional CABG vs. Robotic Bypass Surgery (TECAB)
Explore the table below to understand the difference:
| Feature | Traditional CABG | Robotic Bypass Surgery (TECAB) |
| Chest access | Sternotomy, or opening the breastbone | Small chest incisions |
| Surgical assistance | Direct surgical access | Robotic system |
| Breastbone divided | Usually yes | No |
| Heart-lung machine | May be used | Selected TECAB procedures can be off-pump |
| Scarring | Larger chest scar | Several small scars |
| Recovery | Generally longer | May be faster in suitable patients |
Note: Robotic bypass is not suitable for every individual with coronary artery disease. The best approach is based on factors such as location and severity of blockages, overall health, previous surgeries and the experience of the cardiac surgery team.
Read Also: Robotic Mitral Valve Repair: Procedure, Recovery & Advantages
How Does Robotic CABG Work?
The procedure follows the same basic principle as traditional bypass surgery: create a new pathway for blood to flow around a blocked coronary artery.
Before surgery, the cardiac team evaluates coronary angiography and other tests to check if the blocked vessels can be safely reached using a robotic approach.
During Surgery:
- The patient is given general anaesthesia.
- Small ports are made between the ribs.
- A tiny camera provides a magnified, 3D view of the chest.
- The robotic instruments are inserted through the ports.
- The surgeon harvests an appropriate blood vessel, often an internal mammary artery.
- The graft is connected to the coronary artery beyond the blockage.
- Blood can then flow through the graft to the heart muscle.
- The instruments are removed, and the small incisions are closed.
Important Thing to Note
The robot does not perform the operation independently. Instead, the surgeon sits at a console and controls the robotic instruments. It translates the surgeon’s hand movements into precise movements of the instruments inside the chest.
Read Also: What Is Robotic Heart Surgery and How Does It Work?
Benefits of Robotic Bypass Surgery
One of the biggest benefits of robotic bypass surgery is that it can avoid splitting the breastbone.
Other potential advantages for appropriately selected patients are:
- Smaller chest incisions
- No sternotomy
- Less disruption to chest structures
- Less visible scarring
- Potentially less postoperative pain
- Lower risk of complications associated with a healing breastbone
- Shorter hospital stay in eligible patients
- Faster return to daily activities
- Lowered need for blood transfusion in some cases
- Precise visualisation of the coronary arteries and surrounding structures
Who May Be a Candidate for Robotic Heart Bypass Surgery?
Not every blocked coronary artery can be treated with TECAB; the final decision is made after comprehensive assessment.
A person may be considered for robotic bypass when:
- The coronary artery blockage is suitable for the robotic approach.
- The patient’s overall health permits minimally invasive surgery.
- The heart anatomy is favourable.
- The patient can tolerate the required ventilation and surgical positioning.
- There is no major condition that makes robotic access unsafe.
- The surgical team has appropriate expertise in robotic coronary surgery.
When TECAB Can Be Unsuitable
Previous chest surgery, extensive adhesions, severe obesity, unstable medical conditions or certain patterns of coronary artery disease may make TECAB unsuitable.
What Are the Risks of Robotic Bypass Surgery?
Although robotic surgery uses smaller incisions, like any other heart surgery, it also carries potential risks such as:
- Bleeding
- Infection
- Abnormal heart rhythms
- Heart attack
- Stroke
- Blood clots
- Lung complications
- Graft blockage or failure
- Need for blood transfusion
- Conversion to conventional open surgery
- Need for additional coronary intervention
- Anaesthesia-related complications
There is also a chance that the surgeon may need to switch the minimally invasive procedure to conventional surgery if it is considered safer during the operation.
FAQs About Robotic Bypass Surgery (TECAB)
How long does it take to recover from robotic bypass surgery?
Recovery generally takes 2 to 4 weeks for light activities. However, the recovery timeline varies from person to person. Patients may return to normal activities sooner than after conventional CABG in appropriate cases.
Is robotic CABG safe?
Yes.
Robotic CABG can be safe and effective in carefully selected individuals when performed by an experienced cardiac surgery team.
Is robotic bypass surgery done without opening the chest?
Yes.
TECAB is performed via several small openings in the chest rather than through a traditional sternotomy. The breastbone is not divided.
Conclusion
Robotic bypass surgery (TECAB) offers a minimally invasive way to perform coronary artery bypass surgery in eligible individuals.
But if you ask, is robotic bypass surgery better than traditional CABG? There is no single answer for every patient. The aim of both procedures is to restore blood flow to the heart. Robotic surgery focuses on achieving this goal through a less invasive route; on the other hand, conventional CABG may be more appropriate when coronary anatomy is complex or multiple vessels require treatment that cannot be safely reached robotically.
You just need to follow your doctor’s advice and make an informed decision with them for the best health outcome.
If you have been advised to undergo bypass surgery, ask your cardiac surgeon:
- Am I a candidate for TECAB?
- How many coronary vessels can be treated robotically in my case?
- Would an off-pump approach be suitable for me?
- Would hybrid TECAB be an option?
- What are the benefits and risks compared with conventional CABG?
- How experienced is the surgical team with robotic coronary bypass?
Disclaimer: This blog is for informational purposes only. For accurate information about robotic bypass surgery (TECAB), contact your doctor.
References
- https://jovs.amegroups.org/article/view/141217/html
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8690331/
- https://www.uchicagomedicine.org/conditions-services/heart-vascular/coronary-artery-disease/coronary-artery-surgery/tecab
- https://www.clevelandclinicabudhabi.ae/en/health-library/health-resources/treatments-and-procedures/totally-endoscopic-robotic-coronary-bypass
- https://my.clevelandclinic.org/podcasts/love-your-heart/how-robotic-technology-is-changing-heart-bypass-surgery
