Future of minimally invasive cardiac surgery.

The ultimate goal of minimally invasive cardiac surgery (MICS) is the perfection of totally endoscopic cardiovascular surgery, without the need for thoracotomy; instead opening a number of access apertures ( ≤1 cm), and treatimg cardiovascular conditions using only the endoscope and narrow instruments. The first step on the road to minimally invasive surgery was endoscopic cholecystectomy, commenced in earnest in America and Europe in 1988. This minimally invasive method of removing the gall bladder laparoscopically, without the need for laparotomy, has a high level of patient satisfaction attributable to decreased postoperative pain, better cosmetic appearance due to the lack of a laparotomy scar, and earlier recovery, discharge and return to activities. The introduction of minimally invasive surgery techniques to cardiovascular surgery have been extremely difficult, however, due to the need to manipulate the heart and aorta, usually under cardiopulmonary bypass (CPB), and technical difficulties with endoscopic surgery. Following training and animal experiments, in July 1992 we successfully performed the first endoscopic interruption of patent ductus arteriosus. 1) This success was