The patient is a 75-year-old male with severe, multi-vessel coronary artery disease. Stenotic coronary disease risks include type II diabetes mellitus, essential hypertension, hyperlipidemia, and tobacco smoking. 12 years prior, the patient had percutaneous coronary intervention (PCI) with drug-eluting stents to the left anterior descending (LAD) and right coronary (RCA) arteries. Past medical and surgical history also includes permanent pacemaker, osteoarthritis, gastroesophageal reflux disease. Recently the patient suffered chest tightness and stress testing demonstrated inferior wall ischemia. 2-D echocardiogram demonstrated a left-ventricular ejection fraction of 50%. Coronary angiography revealed 80% LAD in-stent stenosis, 90% stenosis of RCA distal to previous stent, and 80% stenosis of the first obtuse marginal (OM1) and right posterior descending coronary (PDA) arteries. STS mortality risk was noted to be 1.27% and major morbidity risk was 13.6 %, hence he was deemed a good surgical candidate. Preoperative plan was to perform minimally invasive coronary bypass via left anterolateral thoracotomy. Specifically, right and left internal mammary artery grafts (RIMA and LIMA) and a sequential, reversed, greater saphenous vein bypass.