Issues related to TECAB surgery 1. Indications and contraindications As multi-vessel bridge TECAB and “hybrid” procedures have become possible, any patient requiring a bypass can be considered for a fully robotic, minimally invasive procedure. TECAB is not suitable for patients with hemodynamic instability, unsuitable for prolonged one-lung ventilation, history of thoracic surgery, or post-radiation therapy for chest tumors; the quality of the patient’s target vessels should be fully evaluated preoperatively, and should be performed with caution in cases of small chest space and abnormal chest anatomy. anastomosis can be completed within 3 to 5 hours. As the long-term patency rate of drug-eluting stents continues to improve, interventional treatment of non-anterior descending lesions presents a strong challenge to bypass grafting. The “hybrid” procedure is a combination of robotic coronary bypass grafting and stent placement to treat multiple coronary lesions with minimal trauma. A recent study by Katz et al [28] showed that this procedure can be done safely with a low postoperative complication rate and a 96.3% bridge vessel patency rate at 3 months. In China, 178 cases of TECAB or MIDCAB were completed at the PLA General Hospital, and 20 of these patients had combined gyral branch or right coronary restrictive stenosis and underwent substation stenting (hybridization) within 2 weeks after robotic surgery, with good recovery and no adverse cardiac events. The split-station hybridization procedure is more in line with the existing medical conditions, avoiding the demanding requirements of the operating room equipment for the “one-stop” hybridization procedure and avoiding the possible intraoperative formation of intra-stent thrombosis. The near and long-term efficacy of hybridization surgery still needs to be observed in a large number of cases and follow-ups. Compared with median open-heart surgery, different types of robotic coronary artery bypass surgery can significantly shorten the postoperative recovery time. 82% of patients resumed daily activities within 10 days after robotic-assisted small-incision transthoracic coronary artery bypass surgery, as reported by Derose et al. Bonaros et al. compared the postoperative quality of life of patients undergoing AHTECAB with those undergoing intraoperative conversion to median open or original median open chest, and the overall health status scores of TECAB patients were higher after one month. De Canniere et al. reported that 91.2% of AHTECAB and 94.9% of BHTECAB patients were free of cardiac events and cerebral infarction at 6 months postoperatively, and 75.6% of the first patients to receive TECAB were free of cardiac events at 5 years postoperatively.