Minimally invasive cardiac surgery

Cardiopulmonary bypass surgery was invented in 1953. Since then, cardiac surgery has had a prosperous age for several decades. The introduction and evolution of percutaneous coronary intervention, however, was a great challenge to traditional coronary revascularization, one major part of cardiac surgical practices. In fact, the adoption of endoscopic techniques fundamentally changed several surgical disciplines. For the past 10 years, the concept and practice of minimally invasive cardiac surgery has gradually grown in popularity. The growth has been driven by multiple factors. From the patients' point of view, less surgical trauma, a higher margin of benefit/cost ratio, and speedy recovery to normalcy are all desirable. The outlook of less invasive incisions is well elucidated by the general population. From the surgeons' point of view, the adoption and evolution of new techniques and technologies fulfill the learning prospect of the profession, excel to excellence, and may contribute to the patient's welfare. From the viewpoints of health industries, new practices imply new innovation, investment, and business. However, surgeons face obstacles to the development of less invasive approaches. Initiatives are hindered by limited surgical exposure, unfamiliar environments, prolonged operative time, unexpected troubleshooting, etc. Nevertheless, with enabling technologies, refined instruments, and pioneers' lead, cardiac surgery is now heading toward less invasive approaches. More and more cardiac surgeons adopt these techniques and more and more evidence demonstrates the benefits of these approaches. In this article, several update approaches are reviewed. Copyright (C) 2013, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.