What's so minimal about "minimally invasive" coronary bypass surgery?

What is MIDCAB?

A pair of University of Virginia Medical Center surgeons perform a coronary bypass operation, as a third colleague looks on.
A pair of University of Virginia Medical Center surgeons perform a coronary bypass operation, as a third colleague looks on.
William F. Campbell/Getty Images

The rub with traditional coronary bypass surgery is that the patient has his or her chest opened 6 to 8 inches (15 to 20 cm) through the breastbone, the heart is stopped and the body is put on a heart-lung machine in order to keep it alive and kicking. Doesn't sound like too much fun, does it? It does, however, work well. But there are some risks whenever the heart is voluntarily stopped. In 1994, the first minimally invasive direct coronary artery bypass (MIDCAB) surgery was performed in Kentucky. Over an 18-month period in 1995 and 1996, another 40 MIDCABs were performed in the same state.

Since that time, MIDCAB procedures have been perfected and tweaked. If you're a good candidate for MIDCAB (which we'll get to later) you now have a couple of choices for what kind of surgery you can get:

  • Traditional MIDCAB surgery: Only a 2.5 inch (6 cm) opening between your ribs on the left side of your chest is necessary. This is sometimes referred to as keyhole surgery and can be performed by hand or with the help of a robotic arm, operated by the surgeon. This is a good choice for patients who pose a risk by being on a heart-lung machine. One example might be someone who also suffers from chronic pulmonary disease.
  • TECAB surgery: This stands for totally endoscopic coronary artery bypass. Get ready to have your mind blown -- with TECAB, there are only a few openings made and they're each about the size of a dime. Like something from a science fiction movie, the procedure is carried out by a surgical robot called the "da Vinci." A tiny fiber optic video camera is mounted onto a robot arm and is controlled by foot pedals. Why feet? Because the procedure is performed by a surgeon operating two more mechanical arms as if they were his own. There's a joystick, just like a video game, as well as rings the surgeon can insert his fingers into to operate the robot's "fingers." The entire procedure is carried out watching a video monitor.

T­he da Vinci system was approved in 2000 and since then more than 800 of the units have been installed worldwide at a price tag of about 1.5 million bucks each. The makers estimate that about 130,000 surgeries will be performed in 2008 using the system, but not all will be TECABS. Surgeons can also perform hysterectomies and surgeries on the prostate with the da Vinci. If you think the inside of the chest is a bit crowded for a robotic arm, you're right. Doctors solve this issue by deflating one lung to give them more room.

Unfortunately not everyone that needs bypass surgery can opt for the minimally invasive variety. You might be a good candidate if:

  • You have blockage in only one or two coronary arteries.
  • Your blocked arteries are on the front side of the heart.
  • You're healthy aside from your artery blockage.

What are the benefits and risks of MIDCAB and TECAB surgeries?