Left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass has been scientifically proven to have the best patency and long-term results in myocardial revascularization. The latest guidelines suggest minimally invasive LIMA to LAD is the optimal therapy for isolated proximal LAD lesions. The start of a minimally invasive direct coronary artery bypass (MIDCAB) program can be quite challenging as robotic surgery demands high starting costs, while normal thoracoscopic techniques have a longer surgeon learning curve. In this article, we describe to the best of our knowledge the first use of surgeon-guided wristed instruments in LIMA harvesting for MIDCAB surgery. It allows for a facilitated LIMA harvest like in robotic surgery with the comfort of a surgeon constantly standing by the patient, allowing for a faster response time in case of an emergency or the need for instrument exchange. These features result in shorter operating times, lower costs compared with robotic surgery, and faster adoption of this technique for centers just starting MIDCAB surgery.
Keywords: LIMA takedown; MIDCAB; VATS; robotic surgery; wristed instruments.