BACKGROUND: The purpose of this review is to provide recommendations for cardiac surgeons interested in adopting a robotic platform into their programs. METHODS: The recommendations are based on the experience of the authors and cover a diverse array of cardiac surgical procedures that are currently performed with robotic assistance. The focus, as with any innovative surgical approach, is to ensure patient safety, maximize quality and efficacy, and set realistic expectations about what is required to achieve proficiency in robotic cardiac surgery. RESULTS: Even though there may be steady growth in robotic cardiac procedures, it is possible that these procedures will be concentrated in higher-volume programs that already offer expertise in mitral valve or coronary surgery. Once success and proficiency with robotic cardiac approaches to coronary or valvular heart disease is achieved, as outlined in this review, surgeons may wish to embark on more complex robotic procedures, such as reoperative mitral valve surgery, totally endoscopic coronary artery bypass, or aortic valve replacement. CONCLUSIONS: Maintaining the same principles and techniques for coronary surgery or intracardiac procedures and maintaining the fundamentals of myocardial protection and cardiopulmonary bypass are essential to ensure excellent technical and clinical outcomes and to optimize patient safety.