Minimally Invasive Coronary Surgery

Full sternotomy approach remains the gold standard for coronary bypass surgery, mainly because surgery is indicated in case of severe and diffuse lesions which need several bypass with complete revascularization. However, when the number of significant coronary artery lesion is limited to one or two vessels, an alternative to full sternotomy is a small left mini-thoracotomy which provides a space large enough to perform one or two bypass anastomoses under direct vision, using the left mammary artery.

MIDCAB procedure

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This Minimally Invasive technique is well known as MIDCAB procedure (Minimally Invasive Direct Coronary Artery Bypass) and it is recognized as the safer minimally invasive technique in coronary bypass surgery, especially to bypass the LAD.

LAD Coronary Stenosis

The first step is the endoscopic closed chest harvesting of the mammary graft with 3D video assistance.

3D LIMA Harvesting


Then the mini-thoracotomy is done to have access to the coronary vessels. The anastomosis is done on beating heart without cardio-pulmonary bypass (CPB) using myocardial stabilizer.


The very good results obtained with the MIDCAB technique has paved the way to the concept of “Hybrid coronary revascularization” which combined the benefit impact of minimally invasive surgical technique with the low invasiveness of interventional cardiology: MIDCAB is used to LAD revascularization and Coronary Stenting is used for other arteries revascularization in multi-vessel coronary artery disease.

Read more of Hybrid Coronary Artery Bypass Graft here:

Hybrid_CABG [PDF, 1.37 MB]

Totally Endoscopic Coronary Bypass Procedure

Robotic Assistance allows Totally Endoscopic Coronary Bypass (TECAB), which is mainly dedicated to LAD grafting with the left mammary artery. The first stage is the harvesting of the LIMA graft and then the anastomosis to the LAD is done on beating heart without CPB using specific stabilizer. This technique allows complete closed chest CABG procedure.

Totally Endoscopic Coronary Artery Bypass Procedure

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Patient Scare after TECAB


Nowadays, an alternative to TECAB is a Robotic-Enhanced MIDCAB, based on a robotic harvesting of the LIMA graft and an anastomosis to LAD under direct vision through a small mini-left thoracotomy.

Robotic Enhanced Minimally Invasive Direct Coronary Artery Bypass

According to current data, robot-enhanced MIDCAB appears safer and more effective than TECAB; it reduces the rate of primary failure of TECAB technique due to LIMA graft or LAD anastomosis dysfunction.

Read more information of MI Techniques here:

Comparison of MI Techniques in CAD [PDF, 437.08 KB]

Since the introduction and the development of 3D technology in endoscopic minimally invasive approaches, the interest of robotic assistance is less, considering also its overcost.

Read more information of Robotic Cardiac Surgery here:

Robotic Cardiac Surgery Update [PDF, 183.26 KB]