MICS: The Default Choice in the Current Era

The start of minimally invasive cardiac surgery (MICS) marks the beginning of a new era of cardiac surgery. The journey of MICS started back in 1996–1998, initially as MIDCAB (minimally invasive direct coronary artery bypass). Since its inception, adaptation to MICS was slow paced due to lack of proper instrumentation and concepts related to surgical techniques. In spite of early concerns, minimally invasive approaches have emerged as safe and effective alternatives to median sternotomy. Although minimally invasive procedures avoid classical median sternotomy, they are associated with possible complications related to femoral cannulation, myocardial protection, and need for more instrumentation. In the present day, coronary revascularization sternotomy CABG stands ahead as compared to TECAB (totally endoscopic coronary bypass) or robotic CABG. ¹ At present there are very few prospective randomized controlled studies to compare MICS with sternotomy. MIST Trial is ongoing (sternotomy and MICS CABG for multi-vessel coronary artery disease). ² Robotic cardiac surgery was introduced into cardiac surgery as a MICS procedure using the da Vinci system. However, the fact remains that robotic cardiac surgery is far more expensive than the other standard techniques, has a low level of availability, needs proper training centers, and also needs more simplification of robotic instrumentation.

Our counterparts in cardiology have made leaps and bounds in the spectrum of percutaneous interventions. Cardiac surgeons have no choice but to improve their skills in minimally invasive procedures not only to cope up with their peers but also to meet the expectations of patients.

The medical industry has played a crucial role in the development of technology and instruments needed for minimally invasive procedures. But their interest is declining in developing newer methodologies due to the shrinking market of cardiac surgery.

Various procedures that can be done through the minimally invasive way, apart from CABG, are MICS MVR, AVR, hybrid procedures, and some congenital procedures. The review article about MICS elaborated in detail its present scenario.

Cardiac surgeons should innovate catheter-assisted cardiac operations, a logical and future milestone toward MICS. Finally, to cope with the present era, out-of-box thinking is important for cardiac surgeons and to meet expectations of the patient community. Hence, MICS will be the default choice in cardiac surgery.