Introduction: The Critical Questions Every Patient Should Ask

Is Your “Minimally Invasive” Surgery Truly Minimal?

The term ‘minimally invasive’ is often referred to as the gold standard in modern cardiac care. However, many patients don’t realize that it is a broad category that encompasses:

• Various less-invasive procedures that promise general benefits like faster healing and reduced pain when compared to traditional open-heart surgery.
• Many different techniques, including those which still require partial bone cutting or significant trauma to the ribs. The range of post-operative benefits a patient receives varies significantly based on the specific technique used.

To clarify what truly constitutes the least disruptive approach, we spoke with cardiac surgeon Dr. Mario Castillo-Sang, a global pioneer in Totally Endoscopic Cardiac Surgery (TECS) – the most advanced minimally invasive technique available.

To explore the entire scope of this truly minimal approach, Dr. Castillo-Sang shares his expert insight in a comprehensive six-part series titled: Not All Minimally Invasive Heart Surgeries Are Created Equal.

Here are the key components addressed in the series:

Part 1: The Distinction

What’s the difference between the various minimally invasive approaches?

“This is the most crucial distinction patients need to understand,” explains Dr. Castillo-Sang. “The difference isn’t just about the incision – it’s about bone preservation.”

Many procedures labeled ‘minimally invasive’ still involve either partially cutting the breastbone (hemi-sternotomy) or forcefully spreading the ribs (mini-thoracotomy). With TECS the chest wall structure is fully preserved. The whole procedure is performed using a single 2.3cm incision through the natural spaces between the ribs – without cutting bones or traumatizing the ribs.

“The ability to leave the sternum and ribs completely intact is what truly makes TECS unique,” says Dr. Castillo-Sang. “This technique fundamentally changes the patient’s entire recovery journey”

[READ PART 1 NOW: Minimally Invasive vs. Truly Minimal: Decoding the Difference in Cardiac Surgery]

Part 2: The Technology

How does the surgeon see the heart through such a small cut?

With TECS, the small access point doesn’t mean compromised visibility. In fact, the opposite is true. A state-of-the-art 3D 4K endoscope (camera) provides a high-definition, magnified video feed of the surgical field.

Dr. Castillo-Sang notes that this technology provides a superior view of the heart’s internal structures, “The imaging is so sharp and clear. Better vision leads to a more precise, efficient repair.”

[READ PART 2 NOW: Beyond the Naked Eye: How 3D Endoscopic Vision Enhances Surgical Precision]

Part 3: The Structural Advantage

Why is avoiding the breastbone cut so important for recovery?

The breastbone (sternum) is a large, slow-mending structural bone. When it is cut, patients face more discomfort and sternal precautions for 6 to 12 weeks after surgery (no driving, no lifting, no pushing). TECS eliminates this physical obstacle.

“Preserving the sternum and ribs is the single biggest determinant of a fast, pain-free recovery,” says Dr. Castillo-Sang. “When the chest wall is completely stable, we shift the patient’s focus from waiting for bone to heal to actual cardiac recovery.”

[READ PART 3 NOW: The Power of Preservation: Why “No Bone Cut” Means Faster Recovery] 

Part 4: The Patient Benefit

How fast is the recovery after TECS?

Because there is no bone trauma, the recovery timeline with TECS is accelerated. TECS patients typically leave the hospital in a few days, not a week. More importantly, they often regain the ability to drive and lift light weight in a matter of weeks, not months.

“The patient’s independence is the clearest measure of success,” says Dr. Castillo-Sang. “When we can confidently send a patient home in two or three days, that proves the immense benefit of the totally endoscopic approach.”

[READ PART 4 NOW: Weeks or Days? How Truly Minimal Surgery Fast-Tracks Your Return to Life] 

Part 5: The Expertise

How do I know if my surgeon is qualified to perform TECS?

Performing TECS requires a unique level of unassisted manual dexterity to execute complex repairs within a restricted space – without direct visualization of the heart. That level of skill and confidence only comes from a high case volume.

“My advice is simple,” exclaims Dr. Castillo-Sang. “Ask for their numbers. Expertise in totally endoscopic cardiac surgery is a direct function of repetition. A surgeon with low numbers carries an inherently higher learning curve and that is a risk a patient should not have to take.”

[READ PART 5 NOW: The Surgeon’s Skill: Master Matters: Inside the Expertise Behind TECS] 

Part 6: The Versatility

Can TECS be used to treat complex heart conditions?

Absolutely. This is where TECS truly represents the future. This approach allows us to successfully treat a full spectrum of pathologies, including severe structural issues or multiple valve pathologies.

But the vastness of this technique lies in its ability to offer solutions for patients previously deemed inoperable due to their age, comorbidities or prior surgeries. “We’ve successfully operated on individuals turned away elsewhere,” says Dr. Castillo-Sang. “This technology allows us to do more with less – less trauma, less recovery time and less risk. It’s a smarter way to operate.”

[READ PART 6 NOW: Complex Cases, Minimal Incision: The Expanding Horizon of Totally Endoscopic Procedures]

Ready to Discuss Your Truly Minimally Invasive Options?

Totally endoscopic cardiac surgery is revolutionizing how cardiac conditions are treated. If heart surgery is part of your treatment plan, learn how this advanced surgical method is the first step toward your fastest possible recovery. Contact our office today to schedule a consultation with Dr. Castillo-Sang or another member of our team by calling (859) 301-9010 or complete our Online Consultation Form.