Totally Endoscopic Cardiac Surgery (TECS)

Totally Endoscopic Cardiac Surgery (TECS) is a highly specialized minimally invasive option that allows surgeons to perform complex heart procedures through small incisions using high-definition visualization and precision instruments. It is considered the most anatomically sparing approach to heart surgery available today.

Open Heart Surgery Through a Closed Chest

The term “totally endoscopic” refers to a surgical technique in which the entire procedure is performed by viewing a magnified image from a tiny camera inserted through a 2-2.5cm incision located between the ribs along the left side of the torso.

Every movement is performed manually by the surgeon at the operating table using long, slender instruments inserted through the tiny incision. These tools are customized for endoscopic access and require exceptional dexterity and spatial awareness. The surgeon performs intricate repairs while watching a monitor in real time – often suturing delicate valve tissue or navigating complex anatomy with millimeter-level precision.

The thoracic wall remains intact throughout the procedure. There is no bone disruption, no rib spreading and no need for a sternotomy. This approach preserves musculoskeletal integrity and minimizes trauma to surrounding structures – contributing to faster recovery and reduced postoperative discomfort.

Totally endoscopic cardiac surgery demands extensive experience and a rare level of technical skill, combining advanced imaging, microsurgical technique and deep familiarity with cardiac anatomy.

Minimally Invasive Heart Surgery

Tremendous Vision: See Better, Do Better


Our cardiac surgery team uses groundbreaking 3D 4K imaging for an unparalleled view of the operative field – enhancing clarity and depth perception. St. Elizabeth is among the first in the country to invest in a state-of-the-art 3D 4K Endoscope. This pioneering equipment takes TECS to the next level, offering a natural immersive view that provides unparalleled depth perception, greater accuracy and faster surgery.

This enhanced visualization allows us to do more with less – less trauma, less recovery time and less risk.

Watch & Learn: Join Dr. Castillo-Sang as he explains how this innovative technique works, who it’s for and why it’s changing the future of heart surgery.

Procedures performed with TECS

TECS is ideal for most heart conditions, including:

  • Mitral valve repair or replacement – including degenerative prolapse
  • Aortic and tricuspid valve surgeries
  • Atrial septal defect (ASD) closure
  • Barlow’s mitral valve repair
  • Cardiac tumor removal – including myxomas
  • Complex cases like mitral annular calcification
  • Atrial fibrillation (AFib) ablation – often combined with valve repair
  • Select structural heart repairs – including congenital anomalies

Inside the Procedure

  • Preoperative Planning
    Advanced imaging (e.g., TEE, CT) is used to assess anatomy and plan port placement.
  • Anesthesia and Positioning
    Patient is placed under general anesthesia; ports are inserted between the ribs for the camera and instruments.
  • Visualization and Repair
    A 3D 4K camera provides a magnified view of the heart. The surgeon performs the procedure manually using endoscopic instruments.
  • Monitoring and Support
    Cardiopulmonary bypass may be used depending on the procedure. The heart is accessed and repaired without opening the chest.
  • Closure and Recovery
    Ports are removed and incisions are closed with minimal scarring. Patients are extubated (breathing tube removed) in the operating room and typically experience less post-op pain.

The Revolutionizing Recovery Advantage

Choosing Totally Endoscopic Cardiac Surgery (TECS) unlocks the full potential of minimally invasive heart surgery. Because TECS avoids bone disruption and rib spreading, patients often experience a faster, less painful and more mobile recovery compared to traditional open-heart surgery.

Benefit TECS Difference
Incision Size Minimal Scarring: Small 2-2.5cm incision between the ribs on the right side of the chest.
Hospital Stay 30–50% Shorter Stay: TECS patients typically stay 2–3 days in the hospital vs. 5–7 days for sternotomy-based open-heart surgery.
Pain Level Significantly Reduced Pain: TECS patients report lower pain scores starting on post-op day 2 and often require only non-opioid medications like Tylenol.
Recovery Time Up to 50% Faster: Most TECS patients resume normal activities within 2–3 weeks, compared to 6–12 weeks for traditional open-heart surgery.
Restrictions No Sternal Precautions: Because the sternum remains intact, patients avoid lifting and movement restrictions common after sternotomy.

What Should I Ask My Surgeon?

If you’re considering Totally Endoscopic Cardiac Surgery, here are important questions to ask during your consultation — designed to help you understand your surgeon’s experience, approach and how the procedure will be tailored to you:

  • How many TECS procedures have you performed – and for which conditions?
    Understanding your surgeon’s experience with this specific technique and its applications can help you feel confident in their expertise.
  • What training or certifications do you have in endoscopic cardiac surgery?
    TECS requires advanced skill and specialized training. Ask about fellowships, courses, or professional affiliations that support their qualifications.
  • Can you walk me through how this procedure will be performed in my case?
    Invite your surgeon to describe the steps, tools and imaging used – and how your anatomy or condition may affect the approach.
  • What outcomes have you seen with TECS patients – in terms of recovery, complications and long-term results?
    Ask about typical recovery timelines, pain levels and how patients do months or years after surgery.
  • How do you decide between TECS, robotic-assisted, or open-heart surgery?
    This helps you understand their decision-making process and how they personalize care.

Frequently Asked Questions

No. TECS is performed entirely by the surgeon using endoscopic instruments — without robotic arms or a console.

The 3D 4K endoscope (camera) provides a natural, immersive view that mimics direct vision – sending a 5-times magnified video feed of the operative field to a screen positioned right above the patient.

A 2-2.5cm incision is placed through the natural spaces between the ribs along the left side of the chest. This is the reason patients benefit from minimal scarring and excellent cosmetic results.

This is rare, but should it happen, your surgeon may convert to a different approach to ensure safety. Rest assured that our cardiac surgeons also excel in traditional open-heart methods.

Yes, most complex heart procedures, including TECS, still require the use of the heart-lung machine to safely stop the heart and allow the surgeon to perform the repair in a still field. The bypass is accessed through vessels, not the main incision.

TECS is ideal for most heart conditions, including valve surgeries, cardiac tumor removal and surgical ablation procedures for atrial fibrillation (AFib).

In most cases, yes. Our team can help verify coverage with your insurance provider.

Yes, depending on anatomy and overall health. Many patients previously deemed unsuitable for candidates for open surgery may qualify for TECS.

Ask About the Technique – Not Just the Procedure

If your care plan includes heart surgery, it’s okay not to know every detail – but it’s important to thoroughly understand your condition and your treatment options. Ask your surgeon whether totally endoscopic cardiac surgery is appropriate for your case.

Call (859) 301-9010 to schedule a consultation with one of our cardiac surgeons.