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Background:
Obesity poses technical challenges for minimally invasive direct coronary bypass surgery. The aim of this study was to examine effect of body mass index (BMI) on short term outcomes in robotic assisted minimally invasive direct coronary bypass grafting (MIDCAB).
Methods:
From January 2010 to November 2011, 109 patients underwent robotic assisted MIDCAB at single institution. All patients had robotic assisted internal mammary artery mobilization followed by direct bypass to left anterior descending artery via small anterior thoracotomy. The intraoperative and postoperative outcomes were collected in prospectively and were analyzed retrospectively. Spearman analysis was used to determine correlation between BMI and outcomes.
Results:
Average left internal artery (LIMA) mobilization and operative room time was significantly higher in patients with BMI >30 compared to patients with BMI <30.(Average time: LIMA mobilization 40.1 vs 51.3 mins; p=0.008, operating room time: 187.7 vs 218.3 mins;p=0.04). All other postoperative outcomes ( Re-op for bleeding, stroke, renal failure, respiratory failure, periop MI) were not significantly different between both groups.
The outcomes and their correlation with BMI is shown in the table.

Variable	Correlation Coefficient (R)	p value
ORTime (min)	.269	0.005
LIMA Mobilization (min)	.312	0.001
Drainage (cc)	0.123	0.204
Assisted Ventilation Time (min)	0.119	0.218
Time to out of bed to Chair (min)	-0.052	0.59
Time to Ambulate in Hallway (min)	-0.04	0.682
Post Length of Stay (days)	0.12	0.216

Conclusions:
Patients with obesity (BMI>30) have similar post-operative outcomes compared to patients with lower BMI. LIMA harvest time and operative times are longer in obese patients in our experience. Robotic MIDCAB can be performed safely in obese patients.