Robotic coronary revascularization: a scoping review of the published evidence

Abstract

Background
Robotic coronary artery bypass grafting (CABG) has been performed for more than 25 years, but the published evidence base is dispersed across single-center experience, registry analyses, and a small number of trials. A consolidated map of what has been studied, where, and which outcomes have been reported is needed to support clinical decision-making and guide future research. This study aimed to systematically map the published original literature on robotic CABG, characterizing study designs, geography, sample sizes, procedures, and the outcomes reported. A scoping review was conducted and reported in accordance with PRISMA-ScR. PubMed/MEDLINE, Scopus, Embase, and Google Scholar were searched from 1998 to October 2025; 69 additional records were identified from secondary sources. Records were de-duplicated in Covidence; two reviewers independently screened titles, abstracts, and full texts. Editorials, commentaries, reviews, meta-analyses, abstracts, operative-technique articles, laser-revascularization studies, and full texts that could not be retrieved were excluded.


Results

Of 3065 records identified, 2277 unique studies were screened, 595 underwent full-text review, and 369 met inclusion criteria. The evidence base was predominantly observational (cohort 64.8%; case report 17.1%; case series 15.7%); randomized trials accounted for only 1.9% (
n
 = 7). Most studies were single-center (87.8%) and conducted in the United States (39.8%), Germany (8.7%), Canada, and Austria (each 7.9%). Sample sizes were highly skewed (median: 72, IQR: 12–234). TECAB was the most common procedure (43.4%), followed by robotic-assisted MIDCAB (39.0%) and hybrid coronary revascularization (13.0%). Some version of the da Vinci platform was used in 73.0% of studies; ZEUS accounted for 5.4%. Conduit use was dominated by the LIMA (84.8%); the RIMA was reported in 30.4%. In-hospital mortality was the most consistently reported outcome (69.6%); long-term graft patency (24.7%), economic outcomes (6.8%), and patient-reported outcomes (22.0%) were under-reported.



Conclusions
The published evidence on robotic coronary revascularization is abundant but methodologically uneven: the field is dominated by single-center cohort experience, with very few randomized trials and limited reporting of long-term, economic, and patient-reported outcomes. Future research should prioritize multicenter prospective studies, standardized core-outcome reporting, and direct comparison with conventional and minimally invasive alternatives.