This case report presents the first totally endoscopic coronary artery bypass performed with a robotic system in Italy at the Department of Cardiovascular Surgery of Padua University in December 2001. A 66-year-old male, with an indication to a single bypass of the left anterior descending coronary artery using the left mammary artery, was considered eligible for a robot-assisted myocardial revascularization using the da Vinci robotic system. The left internal mammary artery takedown was performed through three 1 cm ports on the thoracic wall. The "end-to-side" anastomosis between the mammary artery and the target coronary artery was totally performed endoscopically on a beating heart by means of a stabilizing device introduced through an additional subxiphoid port. Angiographic follow-up at 1 year showed patency of the graft. Since September 2001, robot-enhanced left mammary artery harvesting has been performed in another 18 patients without complications.