The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on totally endoscopic robotically assisted coronary artery bypass grafting in June 2005. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in June 2008 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


The development of endoscopic surgical techniques with robotic assistance has enabled this technology to be used for coronary artery bypass grafting, known as totally endoscopic coronary artery bypass surgery (TECAB) . Following deflation of the lung, small-port incisions are made at three intercostal spaces through which one robotic arm carrying the endoscope and two arms with surgical implement attachments are introduced. Grafts are harvested from suitable donor sites, and anastomosis is achieved across the diseased coronary artery in one or more vessels.

TECAB treatment of the beating heart is carried out using a stabilisation device, consisting of two branches like those used in the MIDCAB procedure, that hold the site for anastomosis steady while the heart continues to beat and removes the need for cardiopulmonary bypass. The stabilisation device requires an additional chest incision to be made when it is used.

Coding recommendations

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.