How did minimally invasive heart surgery evolve?

Minimally invasive heart surgery (MICS) has undergone significant evolution over the years, driven by advancements in technology and surgical techniques. Here is an overview of the key developments in the history of MICS:

1. Early Development (1990s):

- The concept of MICS emerged in the early 1990s, with the introduction of video-assisted thoracic surgery (VATS) for certain lung procedures.

- Surgeons began exploring the use of smaller incisions and specialized instruments for cardiac surgery.

2. Initial Techniques:

- In the late 1990s, minimally invasive coronary artery bypass grafting (MICS CABG) was performed through a small left anterior thoracotomy (LAT) incision.

- Minimally invasive valve surgery, such as mitral valve repair, was also attempted through small incisions.

3. Thoracoscopic Techniques:

- In the early 2000s, thoracoscopic techniques gained popularity, allowing surgeons to operate through small incisions in the chest without spreading the ribs.

- This advancement led to improved visualization and precision during minimally invasive cardiac procedures.

4. Hybrid Approaches:

- Hybrid surgical approaches, combining traditional open surgery with minimally invasive techniques, were developed to address complex heart conditions.

- For instance, hybrid coronary revascularization combined minimally invasive bypass surgery with percutaneous coronary intervention (PCI).

5. Robotic-Assisted Surgery:

- The late 2000s marked the introduction of robotic-assisted MICS, primarily with the da Vinci Surgical System.

- Robotic surgery provided enhanced dexterity, precision, and 3D visualization, further expanding the possibilities of MICS.

6. Transcatheter Approaches:

- Transcatheter techniques emerged as an alternative to traditional surgery, allowing certain procedures to be performed through catheters inserted into blood vessels.

- Transcatheter aortic valve replacement (TAVR), mitral valve repair, and left atrial appendage closure are examples of such advancements.

7. Off-Pump Techniques:

- Off-pump coronary artery bypass (OPCAB) gained traction, allowing MICS CABG to be performed without the use of a heart-lung machine (cardiopulmonary bypass).

8. Remote and Tele-Surgery:

- Recent advancements have introduced remote and tele-surgery capabilities, enabling surgeons to perform MICS procedures from remote locations using advanced robotic systems.

9. Continued Innovation:

- Ongoing research and technological advancements continue to push the boundaries of MICS, with new techniques and devices being developed to improve outcomes and reduce invasiveness.

10. Multidisciplinary Collaboration:

- The evolution of MICS has been facilitated by multidisciplinary collaboration among cardiologists, cardiac surgeons, interventionalists, and engineers, all working together to optimize patient care.

As a result of these developments, MICS has become increasingly prevalent in cardiac surgery, offering benefits such as reduced pain, shorter recovery times, and improved cosmetic outcomes compared to traditional open surgery.