Robotic-assisted LITA takedown was also utilized, evolving from minimal invasive direct coronary artery bypass used in the original description of hybrid revascularization. It is the experience at our institution that robotic assistance is a significant improvement over the minimally invasive direct coronary artery bypass approach.6 First, visualization within the thoracic cavity and of the LITA is noticeably better. This reduces the chance of injuring the LITA pedicle during takedown. As well, better visualization of the LAD lends to more appropriate placement of the thoracotomy for LITA-to-LAD anastomosis. For this reason, thoracotomy incisions have become considerably smaller. Second, surgical access is improved with robotic assistance, enabling mobilization of the entire LITA graft. Even when an ostial stenosis is the lesion of clinical concern, calcification is likely to be present throughout the entire LAD, and the anastomosis is preferably placed in the mid to distal third of the vessel. By increasing the length of the LITA, a greater area of the LAD is available for LITA-to-LAD anastomosis. This ensures the target anastomosis occurs with a tension-free LITA pedicle to an optimum location free of disease. Finally, robotic assistance negates the need for vigorous costal retraction. Although rare, the potential morbidity associated with costochondral dislocation and rib fracture is significant and would be even more so in an immunosuppressed patient receiving steroid therapy.