Part 6: Complex Cases, Minimal Incision

The Expanding Horizon of Totally Endoscopic Procedures

Throughout this series, we’ve shown how Totally Endoscopic Cardiac Surgery (TECS) transforms recovery by preserving the chest structure and minimizing trauma. But its true power lies in its ability to tackle cases once considered too complex for minimally invasive surgery.

Broadening the Possibilities

Previously, patients with complicated heart conditions – such as severe valve disease, dense calcification, cardiac tumors, or prior sternotomies – faced one option: another large chest incision and a long, difficult recovery.

Reoperations were especially risky because cutting through scar tissue increases problems. For patients considered too high-risk due to their age, prior operations, or having other chronic health concerns – surgery wasn’t even offered.

How TECS Changes the Game

The totally endoscopic technique allows skilled surgeons to perform intricate operations through a single tiny incision – using a 3D 4K endoscopic system to navigate tight spaces, avoid scar tissue and repair the heart without opening the chest.

This highly advanced approach reduces pain, shortens recovery and lower risks – even for patients who were formerly told “no.”

“The range of totally endoscopic surgery is immense,” says Dr. Mario Castillo-Sang, a Cardiac Surgeon at St. Elizabeth. “More patients can now get the life-changing treatments they need – we’re offering hope to patients who previously didn’t have options.”

The Versatility of TECS

TECS isn’t a trend, it’s the future. At St. Elizabeth, this innovative technique is safely and effectively being used to treat an ever-expanding array of cardiac conditions, including:

• Mitral Valve Repair & Replacement: TECS enables surgeons to repair or replace the mitral valve without cutting the breastbone, even in cases of severe prolapse or complex reconstruction.
• Mitral Annular Calcification (MAC): This highly challenging condition involves severe calcification of the valve ring. TECS allows surgeons to manage MAC through minimal access with precision.
• Tricuspid Valve Surgery: The tricuspid valve is located on the heart’s right side, TECS uses specialized posterior access to repair or replace the valve, avoiding the sternum entirely.
• Aortic Valve Surgery: As the heart’s main outflow valve, its anterior location and dense surrounding tissue make performing this minimally invasive procedure a unique technical challenge that requires advanced TECS mastery.
• Atrial Septal Defect (ASD) Closure: This common congenital heart defect involves a hole in the wall separating the upper chambers of the heart, with TECS it is repaired through a tiny incision instead of a full chest opening.
• Surgical Ablations for Atrial Fibrillation (Afib): TECS enables precise ablation patterns to restore normal rhythm without the invasiveness of open surgery.
• Cardiac Tumor Removal: Safely and completely removing masses or tumors from the heart requires meticulous precision – TECS makes this possible without opening the chest.
• Repeat Operations: For patients who have had prior sternotomies, TECS avoids cutting through the dense scar tissue, reducing risk and improving recovery.

The ability to successfully tackle such an ambitious range of conditions demonstrates the usefulness of this innovative approach. Our cardiac surgery team performs totally endoscopic minimally invasive procedures at a level that rivals major academic centers throughout the country – and world.

Innovation That Puts Patients First

At St. Elizabeth, we believe that progress isn’t just about adopting new technology – it’s about transforming care for the people who trust us with their health.

Dr. Castillo-Sang  emphasizes this by saying, “We’re proud to be at the forefront of advancing cardiac surgery. TECS represents more than the future of cardiac surgery, it’s the future of patient care. This approach genuinely allows us to provide our patients safer results, stronger recoveries and brighter futures.”

This is the final chapter in our six-part series. We hope this journey has given you a clear understanding of why we set out to emphasize this crucial message: not all minimally invasive heart surgeries are the same.

Call (859) 301-9010 today to schedule a consultation with Dr. Castillo-Sang and discover if this truly minimal approach is right for you.

Catch up on the series: You just read Part 6 of 6.

Read Introduction: Is Your “Minimally Invasive” Surgery Truly Minimal?

Read Part 1: Minimally Invasive vs. Truly Minimal: Decoding the Difference in Cardiac Surgery

Read Part 2: Beyond the Naked Eye: How 3D Visualization Enhances Surgical Precision

Read Part 3: The Power of Preservation: Why “No Bone Cut” Means Faster Recovery

Read Part 4: Weeks or Days? How Truly Minimal Surgery Fast-Tracks Your Return to Life

Read Part 5: The Surgeon’s Skill: Mastery Matters: Inside the Expertise Behind TECS

Medically reviewed by Mario Castillo-Sang, MD, on 12/31/2025.