Myongji Hospital has become the first institution in Korea to successfully perform a totally endoscopic coronary artery bypass grafting (TECAB) without the use of a heart-lung machine, using the da Vinci Xi surgical robot.

The landmark procedure was carried out by Professor Kim Min-seok and his cardiovascular and thoracic surgery team on a patient in his 60s who had been diagnosed with angina.

This high-level surgery combines the advantages of robot-assisted surgery, including no sternotomy, with the benefits of off-pump coronary artery bypass grafting, which avoids the need to stop the heart and use cardiopulmonary bypass.

Coronary artery bypass grafting (CABG) is a standard procedure for patients with narrowed or blocked coronary arteries due to conditions such as angina or myocardial infarction. Traditionally, CABG involves splitting the breastbone, stopping the heart, and using a heart-lung machine to circulate blood, a process associated with risks such as stroke and systemic inflammation.

In contrast, off-pump CABG allows surgeons to operate while the heart continues to beat, reducing recovery time and lowering the risk of complications. However, the technique demands exceptionally high surgical precision because it requires connecting blood vessels just one to two millimeters in diameter on the moving heart.

The Myongji team’s TECAB procedure was performed by making several small incisions in the chest to insert a surgical camera and robotic arms, avoiding any sternotomy. With the da Vinci Xi system providing magnified three-dimensional visualization up to tenfold, the team was able to carry out the delicate vascular connections with enhanced precision.

The result was a minimally invasive procedure with significantly less bleeding, minimal scarring, reduced postoperative pain, and faster recovery, allowing the patient to return to daily activities more quickly.

Globally, fewer than 10 centers are known to perform robotic off-pump coronary artery bypass surgery, and procedures using the da Vinci Xi system are available at only about five hospitals worldwide, largely due to technical and equipment constraints.

By successfully overcoming these challenges, Myongji Hospital has demonstrated its capacity to perform advanced robotic cardiac surgeries in Korea.

“This procedure was only possible thanks to our extensive experience with hundreds of off-pump and minimally invasive CABG surgeries, as well as robotic operations,” Professor Kim said. “With the clinical expertise we have built at the MJ Heart & Vascular Center and seamless teamwork with the anesthesia team and other medical staff, we aim to advance outcomes in cardiovascular disease treatment and contribute to the evolution of cardiac surgery.”