A modern minimally invasive approach to treat coronary heart disease - the most commonly acquired heart disease.

The UK's first robotic minimally invasive coronary artery bypass was performed in 2000 at Royal Brompton Hospital. Since then, over 700 have been performed on single and multiple vessel coronary heart disease.

The traditional route to access the heart for a coronary artery bypass graft (CABG) procedure is via a median sternotomy (a vertical incision dividing the breastbone). This requires a three month period of recovery until strength is restored.

However, the EndoACAB procedure - conducted by Mr Anthony de Souza and Ms Rashmi Yadav - avoids this division of the sternum.

What is EndoACAB?

EndoACAB is a minimally invasive approach, avoiding a large incision or division of the sternum, using advanced endoscopic techniques. The procedure involves using a voice-controlled robotic hand telescope to harvest the internal mammary artery from the chest wall, using three holes which are 5mm wide.

A small incision is then made between the ribs and, without any spreading, the bypass is performed to the left anterior descending artery - the main artery supplying the heart.

This procedure is performed off-pump without the need to stop the heart or use a cardiopulmonary bypass 'heart lung machine'. Patients experience less pain, minimal scarring and faster recovery times.

Who would benefit from an EndoACAB?

Anyone who has been recommended for a CABG could be considered for an EndoACAB. For patients with just left anterior descending (LAD) coronary artery disease, the EndoACAB procedure may be all they require. However, if the patient has multiple narrow arteries, the hybrid procedure might be a more appropriate form of treatment.

The hybrid procedure

The ‘hybrid’ procedure draws together the benefits of both techniques - EndoACAB and stenting of the coronary artery. This allows for a well-proven treatment: a left interior mammary artery (LIMA) to LAD bypass, with drug-eluting stents inserted in the remaining less important arteries. This procedure is performed during the same hospital stay.

The advantages of EndoACAB

In a review of our patients when compared to conventional CABG with sternotomy, the EndoACAB group was ventilated for a shorter time, bled less and stayed in hospital for a shorter period of time.

In addition, patients resumed normal activity more quickly, with more returning to employment.

This article was originally published in March 2014, and was edited in March 2019.


Mr Anthony de Souza

Consultant cardiac surgeon, Director of surgery and theatres at Royal Brompton Hospital




Ms Rashmi Yadav

Consultant cardiac surgeon