A team led by cardiac surgeon Univ.-Prof. Dr Andreas F. Zierer at Kepler University Hospital (KUK) has performed Austria’s first two robot-assisted coronary bypass operations on beating hearts.
The two patients, aged 84 and 54, were transferred to a regular ward on the first day after surgery.
The successful procedures mark an important step in the development of minimally invasive cardiac surgery at KUK. The hospital’s next goal is to establish an interdisciplinary Enhanced Recovery After Surgery (ERAS) programme at its Heart Centre, designed to support faster recovery following surgery.
In recent years, Prof. Zierer and his team have developed KUK’s Heart, Vascular and Thoracic Surgery Centre in Linz and Wels into one of Austria’s leading centres for totally endoscopic cardiac valve surgery, using minimally invasive techniques.
First robot-assisted bypass procedures at KUK
Building on this experience, Prof. Zierer and an interdisciplinary team of cardiac surgeons, anaesthetists, perfusion specialists and operating theatre staff performed the two robot-assisted bypass procedures on 26 July 2026.
The operations were carried out on beating hearts, without the use of a heart-lung machine. The team was supported by Štěpán Černý, MD, PhD, a European pioneer in robot-assisted cardiac surgery and head of cardiac surgery at Motol University Hospital in Prague.
The KUK team had spent around a year preparing for the procedures.
Both patients were transferred to a regular ward on the first postoperative day. The 54-year-old patient was already mobile and reported almost no symptoms, while the 84-year-old patient was also mobilised and reported no further pain.
Advantages of robot-assisted cardiac surgery
Robot-assisted cardiac surgery, typically performed using the da Vinci system, allows surgeons to operate through very small access points rather than opening the chest through a conventional sternotomy.
The robotic system does not operate independently. Instead, it translates the surgeon’s hand movements at a console into precise movements of miniature instruments inside the chest, filtering out natural hand tremor.
Avoiding a sternotomy eliminates the need for the breastbone to heal and can significantly reduce blood loss and the risk of wound infection. Smaller access points can also contribute to less postoperative pain and shorter hospital and intensive-care stays.
Robot-assisted bypass surgery can offer further advantages compared with conventional endoscopic techniques. The robotic system allows surgeons to control the forces applied where the instruments enter the chest, helping to minimise pressure on surrounding tissue, including nerves. This enables smaller incisions and may support faster mobilisation and recovery.
In Europe, we are currently on the threshold of a revolution in cardiac surgery. With new robotic systems approaching European approval, it could become possible to perform up to half of cardiac procedures using highly minimally invasive techniques. For patients, this could mean less postoperative pain and shorter recovery periods, with hospital stays potentially reduced by up to half.
Prof. Dr Andreas F. Zierer
KUK plans to introduce ERAS programme
Following the successful introduction of robot-assisted cardiac surgery, KUK plans to expand the programme and introduce ERAS at its Heart Centre.
The Enhanced Recovery After Surgery approach aims to reduce the physical stress associated with surgery, accelerate recovery and help patients regain independence as quickly as possible.
The programme will cover three stages:
- Before surgery: Patients will receive preparation and support from specialised ERAS nurses, including breathing exercises, nutritional optimisation and psychological preparation.
- During surgery: Short-acting anaesthetics and specialised pain-management techniques will support a fast-track approach, allowing patients to wake and discontinue mechanical ventilation as soon as possible.
- After surgery: Early mobilisation and nutrition will be prioritised, with patients encouraged to sit up within hours and usually begin walking on the first day.
The ERAS programme will bring together cardiology, cardiac surgery and anaesthesia, alongside nursing, physiotherapy and dietetics teams.
KUK CEO Univ.-Prof. Dr Meinhard Lukas said the programme would be an important step towards optimising clinical processes across the university hospital, while reducing unnecessary diagnostic and therapeutic interventions and supporting faster patient recovery.
Pictures: KUK / Sulzbacher
