TY - JOUR. T1 - Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. AU - Hong, Soon Jun. AU - Lim, Do-Sun. AU - Seo, Hong Seog. AU - Kim, Young Hoon. AU - Shim, Wan Joo. AU - Park, Chang Gyu. AU - Dong, Joo Oh. AU - Young, Moo Ro. PY - 2005/1/1. Y1 - 2005/1/1. N2 - The aim of this study was to assess the effects of percutaneous coronary intervention with drug-eluting stents (DESs) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery in the management of patients with proximal left anterior descending (LAD) coronary artery stenosis. Until recent years, despite the advantages of percutaneous transluminal coronary angioplasty (PTCA) with bare metal stent implantation, such as shorter hospital stays and recovery time, MIDCAB showed better results with regard to the need for repeated intervention in the target vessel than PTCA with ...
Minimally Invasive Surgical Technique (MIST) - Modified Minimally Invasive Surgical Technique (M-MIST), Dr. Pierpaolo Cortellini & Dr. Maurizio Tonetti
CEMASTs Minimal Access Surgery Training Center is a state-of-the-art training center and one of Indias best places for surgeons to take hands-on training and is a dream come true for any surgeon who wishes to practice safe minimal access surgery. Beginners and even expert surgeons can find it difficult to complete knot-tying & suturing procedures, CEMASTs gives them the perfect environment to hone their intensive minimal access pediatric surgery skills. This training course gives an opportunity for everyone to get hands on training and become an expert in the respective area ...
Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial. ...
The objective of M.S (Minimal Access Surgery) course is to develop an understanding of key issues in the evaluation of minimal access surgical procedures and assessment of surgical health outcomes. World Laparoscopy Hospital is the First Institute in Asia to start M.S (Minimal Access Surgery) University Degree Course. This unique University Degree course aims to meet the personal, professional and educational requirements of surgeons continuing their professional development within the clinical field of laparoscopic surgery.. ...
The objective of this study was to assess systematically the available scientific evidence relating the efficiency of minimally invasive surgical procedures in accelerating orthodontic tooth movement and the adverse effects associated with these procedures. Electronic search of these databases CENTRAL, EMBASE, Scopus, PubMed, Web of Science, Google Scholar Beta, Trip, OpenGrey and PQDT OPEN was performed (last updated January 2016). The reference lists of the included studies were hand searched. Unpublished literature and ongoing studies were also checked electronically through ClinicalTrials.gov and (ICTRP). Randomized controlled trials (RCTs) with patients who received minimally invasive surgical procedures combined with fixed orthodontic appliances compared with conventional treatment were included. Cochranes risk of bias tool was used to assess risk of bias. Four RCTs (61 patients) and nine ongoing protocols were included in this review. Only three RCTs were suitable for quantitative synthesis.
This book A Color Atlas of Minimal Access Surgery in Children has been carried out with a vision toward the bright future of endoscopic surgery in children. A pictorial representation of simple and more advanced pediatric endoscopic surgical cases providing the viewers with a rare glimpse into the world of expert surgeons form around the globe. Ample stress has been laid on the preferred modality of management of empyema, i.e. primary VATS (video assisted thoracic surgery). Employs minimal access surgery (MAS) techniques to newborns and informs that a thoracoscopic approach works better in congenital diaphragmatic hernia in the neonatal age group. The entire text is divided in 7 sections, namely Infrastructure and instrumentation, preparing for Laparoscopy, Laparoscopy for gastrointestinal system, laparoscopy for urogenital system, thoracoscopy, research and documentation. This book is a great utility to surgeons who want to develop their skills in endoscopic surgery.
S2206 HCPCS code descriptors - Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
Despite extensive soft tissue reduction, the most common complications associated with Baha implants are related to adverse skin reactions around the abutment. The reduction of the skin also adds complexity to the surgical procedure that is otherwise a routine type of skin incision. A less invasive surgical technique avoiding reducing the thickness of the skin would render a simpler and shorter procedure and would be aesthetically appealing to the patients, as permanent hair removal in the area around the abutment would not be required. Faster healing and less numbness (sensory loss/ paraesthesia) at the implant site may also be expected if the soft tissue thickness is left intact.. The Cochlea Baha BA300 Abutment together with a surgical procedure that includes soft tissue reduction was CE marked in April 2010. The test abutment, Cochlear Baha BA400, together with a surgical procedure that does not require soft tissue reduction was CE marked in June 2012.. The rationale behind this ...
The present invention provides a group or kit of surgical instruments for use in minimally invasive surgical procedures. In one embodiment, the invention is an instrument with a generally central longitudinal axis and a generally toroidal surface generally transverse to the axis, wherein the convex portion of the surface does not extend beyond a line parallel with the longitudinal axis along an outer diameter of the instrument, and the surface has a continuous edge having a first end at a shoulder and a second end at the shoulder and spaced from the first end; in another embodiment, the instrument has a working end with a generally longitudinal axis, the working end defined by a generally curved surface along the longitudinal axis, wherein the curved surface has a concave portion and a convex portion, and wherein the working end has a generally flat tip; in another embodiment, the surgical instrument includes a working end having a generally central longitudinal axis and a surface generally
A method and apparatus for performing a minimally invasive total hip arthroplasty. An approximately 3.75-5 centimeter (1.5-2 inch) anterior incision is made in line with the femoral neck. The femoral neck is severed from the femoral shaft and removed through the anterior incision. The acetabulum is prepared for receiving an acetabular cup through the anterior incision, and the acetabular cup is placed into the acetabulum through the anterior incision. A posterior incision of approximately 2.5-3.75 centimeters (1-1.5 inches) is generally aligned with the axis of the femoral shaft and provides access to the femoral shaft. Preparation of the femoral shaft including the reaming and rasping thereof is performed through the posterior incision, and the femoral stem is inserted through the posterior incision for implantation in the femur. A variety of novel instruments including an osteotomy guide; an awl for locating a posterior incision aligned with the axis of the femoral shaft; a tubular posterior retractor
Matias Bruzoni, MD, Craig T. Albanese, MD, MBA INTRODUCTION Minimal access surgery (MAS) in the pediatric population has progressed immensely over the last 20 years, and more than 80% of the pediatric surgeons in North America are now performing laparoscopic and thoracoscopic procedures.1 Smaller and more precise technology has helped surgeons adapt to the limited space that the small patients chest and abdomen offer. However, these techniques require new and different skills that are not free of errors or complications. The main difficulties surgeons face when performing MAS are more pronounced when operating in smaller spaces. These inherent limitations include 2-dimensional images; minimal haptic feedback (direct touch); operating at a distance with very thin instruments; motion parallax and poor ergonomics, such as limitations in directional movement and mobility of the instrumentation. The safety of minimally invasive surgery in children has raised much concern and yielded multiple studies.
Minimal access surgery is completed with one or more small incisions instead of a large incision. The surgeon passes a telescope with a video camera through a small incision (usually only 1/4 long) into a body cavity. The surgeon then views the surgery on a TV monitor. Surgical instruments are then passed through other similar little incisions. The surgeon examines and operates on the area in question by viewing magnified images on a television. When the telescope is used to operate on the abdomen, the procedure is called laparoscopy.
BACKGROUND This study reports our 28 months experience with minimal access surgery (MAS) in children. MATERIALS AND METHODS This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibility of MAS in neonates, in the appropriate operative groups. RESULTS A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical
The MASTER IN MINIMAL ACCESS SURGERY is one year degree course conducted by Laparoscopy Hospital is an important postgraduate opportunity for Surgeons and Gynaecologists to be trained in laparoscopic surgery and its underpinning technologies in depth for one year
Minimal access surgery (MAS) is a surgical technique similar to laparoscopy, but further advances the technique by using a single port, usually located at the umbilicus.
We are proud that you have chosen to be with us in your pursuit of clinical excellence in your chosen field of Minimal Access Surgery.
Follow-up of internal mammary artery stent with 64-slice CT. Erica Maffei; Giancarlo Casolo; Nico Mollet; Bob Meijboom; Jurgen Ligthart // International Journal of Cardiovascular Imaging;Aug2007, Vol. 23 Issue 4, p537 Abstract  We present a case of 81-year-old woman complaining chest pain after minimal efforts who underwent multiple coronary artery bypass grafts (CABGs) during the last 15 years. A significant in-stent re-stenosis was found at ostium of left internal mammary artery (LIMA). A... ...
Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts.
We offer Foot and Ankle Arthroscopy (Minimal Invasive Surgery) for treating and diagonsis of Foot and Ankle problems. 2 Locations. Call 818-981-1900
Less invasive surgical techniques have transformed surgery in many fields, including cardiothoracic surgery. Smaller incisions mean less blood loss, less discomfort, a shorter hospital stay, and a faster recovery.. Weill Cornell Medicines Department of Cardiothoracic Surgery specializes in many minimally invasive surgical techniques. In fact, our surgeons have pioneered many of these approaches.. Our surgeons specialize in:. Transcatheter aortic valve replacement (TAVR): This minimally invasive approach repairs or replaces a diseased heart valve by threading a catheter up to the heart through a blood vessel in the groin.. Weill Cornell surgeons were leaders in the clinical trials that established this techniques effectiveness.. Mini-sternotomy or partial sternotomy: Many procedures, such as aortic valve replacement, mitral valve repair/replacement, and aneurysm repair can be performed through a small incision and partial sternotomy. This is an alternative to traditional, "open-heart" surgery. ...
What is minimal invasive cardiac surgery (MICAS)? Minimally invasive heart surgery (also called keyhole surgery) is a newer form of cardiac surgery. In this
Clinical Trials - clinicaltrials.gov Comparison of the clinical effectiveness and cost-effectiveness of the MIS anterolateral approach (MIS Watson Jones, G3) ve...
The objective of M.S (Minimal Access Surgery) course is to develop an understanding of key issues in the evaluation of minimal access surgical procedures and assessment of surgical health outcomes. World Laparoscopy Hospital is the First Institute in Asia to start M.S (Minimal Access Surgery) University Degree Course. This unique University Degree course aims to meet the personal, professional and educational requirements of surgeons continuing their professional development within the clinical field of laparoscopic surgery.. ...
A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.
|span||b|Introduction:|/b| Hospital response to the COVID-19 outbreak has involved the cancellation of elective, deferrable surgeries throughout Europe in order to ensure capacity for emergent surgery and a selection of elective but non-deferrable surgeries. The purpose of this document is to propose tech|/span| …
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Advances in the field of medicine have resulted in new and less painful surgical procedures. Scars post surgery are now a thing of the past.. At SHRC, surgery includes a full suite of specific sub specialities, led by experienced and capable surgeons who will decide the best procedures for our patients based on their condition.. We have in-depth experience in the field of Minimal Access Surgery (MAS) or key hole surgery. MAS, as the name indicates, involves minimum incision or cutting open of the body. This is achieved through small openings or cuts made on the skin. In some cases, natural openings can also be used to gain entry into the body. MAS procedures are carried out with the help of miniature video cameras, fiber optic light sources and specially designed instruments.. ...
Heart Port Surgery include minimally invasive direct coronary artery bypass, Off-pump coronary artery bypass, valve repair and Lead placement.
Minimally Invasive Cardiac Surgery, also known as MICS CABG (Minimally Invasive Cardiac Surgery/Coronary Artery Bypass Grafting) or The McGinn Technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an anterolateral mini-thoracotomy. Advantages of Minimally Invasive Heart Surgery are less blood loss, reduced post-operative discomfort, faster healing times and lowered risk of infections, as well as eliminating the possibility for deep sternal wound infection or sternal non-union. This procedure makes heart surgery possible for patients who were previously considered too high risk for traditional surgery due to age or medical history. Patients referred for this procedure may have Coronary Artery Disease (CAD); aortic, mitral or tricuspid valve diseases; or previous unsuccessful stenting. MICS CABG is ...
What is minimally invasive cardiac surgery?. Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeons hands through these small incisions in performing the operations. ...
Course Information. A single day course covering the principles of management of injuries to the bones and soft tissues of the hand and wrist. Designed for surgeons at the earlier stages of their training.. The faculty of leading orthopaedic and plastics hand surgeons will explain the principles of diagnosing and managing fractures and tendon injuries to the hand and wrist, prior to supervised practical workshops using prosthetic and animal models.. Course Objectives. Understand the applied anatomy of the hand and ...
Minimal access spinal surgery (MASS) is a procedure that permits the spinal surgeons to perform very complex and sophisticated surgical procedures through very small (keyhole) incisions. It is aimed to reduce approach-related morbidity and damage of tissues. It complements the minimally invasive spinal surgery by allowing direct visualization of the spine and gives same clinical outcomes of traditional open procedures. All these have been possible only because of the recent advances in both instrumentation and microsurgical tools required for spinal surgery.. Common conditions that are being routinely treated using MASS include:. ...
Mr Brian Dobbins, Consultant General Surgeon, MB ChB, FRCS (Glasg), FRCS (Gen Surg) at Spire Healthcare. Learn more about this consultant here.
The present invention relates to surgical retractors and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with minimally invasive coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices especially configured for use with each other for such surgical procedures wherein the retractor includes an external rail system which enables the surgeon to position a stabilization arm on either of the arms or the rack segment of the retractor and also includes a connector which releasably controls the rotation of the connector with respect to the retractor and the rotation of the stabilization arm with respect to the retractor as well as the rotational and sliding movement of the stabilization arm with respect to the connector upon actuation of a single knob or actuator.
The present invention relates to suture organizing and retaining device for use with surgical retractors and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to a suture organizing device that is attachable to surgical retractors or is usable separately in connection with minimally invasive coronary artery bypass grafting surgical procedures and heart valve procedures, and more specifically to a suture organizing device having a plurality of suture slots thereon for the releasable attachment of sutures thereto during a surgical procedure to enable the surgeon to retract tissue from the surgical field and wherein the suture organizing device is oriented to extend laterally of the outer surface of the arms of the surgical retractor or in combination with a base member that may be independently positioned adjacent to the surgical site.
Jennifer Rosen, MD, Aaron Size, Yuzhang Yang, Andre Sharon, PhD, Alexis F Sauer-Budge, PhD. Boston University School of Medicine, Fraunhofer USA - CMI.. INTRODUCTION: Compared with traditional open surgery, minimally invasive surgery may improve recovery and patient satisfaction while maintaining surgical principles. Laparoscopic, single incision, natural orifice and robotic approaches each hold their own appeal. However, they lack the ability to manipulate organs as easily as the human hand. The downside of adding hand-assistance is that it requires an additional larger incision. Robotic surgical systems are expensive, require a great deal of training, and thus their use is limited. Advances in minimally invasive surgical techniques will require new types of surgical tools with increased functionality of the end effectors. Multifunctional tools that also improve its dexterity with respect to those currently available are highly desired.. DESCRIPTION OF METHODS: To address this challenge, we ...
ERUS 2018 the effect of minimally invasive surgery on the return to work of patients, cost of robot-assisted procedures, do robotic radical prostatectomy have a shorter hospital stay compared to open procedures, cost-effectiveness of robotics in urological surgery.
Lesser trauma to organs, muscles, tissues and nerves. -Shorter hospital Stay. -Increased safety (low risk for infection). -Minimal Scarring. -Faster recovery Period. -Less chance for infection. What are surgeries are usually performed using MIS?. Create a body structure pointing out the different parts of the body. Top surgeries performed in the TMCI.. Gallstone disease - Diseases of the Gall bladder - Laparoscopic Cholecystectomy. Appendicitis - Ruptured appendix - Laparoscopic Appendectomy. Colon cancer - Colorectal Diseases - Laparoscopic Colorectal Surgery. Additional Surgery procedures are then linked, when clicked, zooms out). What are the signs and symptoms of the disease?. (When clicked, image zooms in containing the files). Differentiating factors of the TMC Iloilos MIS Program:. The Medical City -Iloilos Minimally Invasive Surgery Program are composed of trained and highly specialized surgeons. adept in various minimally invasive surgical procedures. Their optimum training and ...
Kyphoplasty is an outpatient procedure used to treat compression fractures in the spine. A compression fracture is when all or part of a vertebra collapses due to problems like osteoporosis (thinning of the bones), cancer or injury. We insert a special balloon through the needle, into the bone, and inflate it. The balloon can help to restore the vertebra to its original shape. Bone cement is injected into the space to impart stability and make sure it does not collapse again.. ...
Minimally-invasive surgery can offer patients many positive outcomes including less pain, shorter recovery time and a shorter length of stay in the hospital. Laparoscopic surgery is used for many different types of treatment. With this type of surgery, a surgeon places a camera inside a patients body through several small incisions. This way, there is a smaller incision for the patient, but the surgeon can still see the way he or she could through a larger incision. Robotic surgery is on the leading edge of surgical care. Surgeons use computer-guided tools to operate with unparalleled precision, dexterity and control enabling complex surgical procedures with smaller incisions. Spartanburg Regional offers many options for minimally-invasive surgery including, but not limited to, the below. ...
An Event in Late August-Early September, this multispecialty conference of a number of MIS Societies, helps increase knowledge of laparoscopic, endoscopic, and minimally invasive surgical techniques. The Meeting consists of Postgraduate Masters Classes; Plenary Sessions; Lap Updates of multiple topics; Expert review and discussion of surgical videos showing accidents, mishaps, and surprises; Deconstruction of video-taped surgeries performed by master surgeons; Exhibitions; Competitions for Best Papers, Videos, and Posters from Professors to Fellows and Residents; Future Technology Sessions; and over 200 General Surgery, Gynecology, Urology, and Multispecialty Scientific Presentations. ...
Highly specialized international hospital focused on minimally-invasive spinal neurosurgery and minimally-invasive orthopedic surgery. Located in Zagreb, Croatia.
Definition of MIDCAB in the Legal Dictionary - by Free online English dictionary and encyclopedia. What is MIDCAB? Meaning of MIDCAB as a legal term. What does MIDCAB mean in law?
A micro-discectomy is spine surgery that involves removing all or part of a diseased or damaged intervertebral disc to relieve pressure on the spinal nerve(s) in the lumbar (lower back) or cervical (upper/neck) spine using minimally invasive techniques. Our neurosurgeons are skilled to perform this procedure using the latest minimally invasive surgical techniques. Minimally invasive spine surgery involves a small incision or incisions and muscle dilation, allowing the surgeon to separate the muscles surrounding the spine rather than cutting them. Your neurosurgeon will determine if this the best option for you.. In addition to removing all or part of the disc any bone material (bone spurs) that are pressing on the nerves and causing pain will also be removed during the procedure. Because it eliminates nerve/nerve root compression, a discectomy is also known as a decompressive spinal procedure.. A discectomy may be performed in conjunction with spinal fusion. This involves placing bone graft or ...
These minimally invasive surgeries are offered to improve fertility in subfertile couples. Laparoscopy is a minimally invasive surgical technique where a small cut is made in the umbilicus, the abdomen is distended with gas and then laparoscope-camera is inserted to evaluate the reproductive organs such as the uterus, tubes and ovaries.. The laparoscopic technique can be used to perform tubal surgeries to improve fertility in women with blocked tubes and also in women with endometriosis to improve fertility. Laparoscopic surgery is also performed to treat pelvic pathologies such as ovarian cysts, removal of scarring around the tubes and ovaries and also in certain cases to remove the fibroid. ...
Arnold Advincula, MD, FACOG, FACS. Vice-Chair of Womens Health & Chief of Gynecology at Columbia University Medical Center (CUMC). He is the Levine Family Professor of Womens Health in the Department of Obstetrics and Gynecology and serving as Medical Director of the Simulation Center. A leader in minimally invasive surgical techniques and one of the worlds most experienced gynecologic robotic surgeons who has published and taught extensively in the area of minimally invasive surgery as well as developed surgical instruments in use worldwide. He is a board certified obstetrician-gynecologist and fellow of the American College of Surgeons. ...
Surgical removal of cancer remains an integral part of the treatment strategy for patients with Stage II colon cancer and many patients are cured with this treatment alone. Conventional surgery involves opening the pelvis and/or abdomen to gain access to the large intestine. As with any surgery, there are risks associated with removing cancer, including infection, blood loss, and other possible complications of surgery.. Clinical trials have shown that a less invasive surgical technique, called laparoscopic surgery, may be more tolerable than and similarly effective as conventional surgery. Laparoscopic surgery involves the placement of small probes into the area of surgery. The probes contain cameras and instruments for removing the cancer. The surgeon performs the surgery through the probes while watching his or her movements captured by the camera and projected on a large screen. This type of procedure prevents the need for large surgical incisions, and may be associated with fewer ...
Arthroscopy is a minimally invasive surgical technique that can be used to accurately explore and treat issues in virtually any joint in the horse.. Arthroscopic surgery generally involves two very small (8mm) keyhole incisions. The first incision is where the surgeon will insert the arthroscope, which is an instrument with a small surgical grade camera installed that allows a complete, clear view of the interior jointsurface. The second small incision is created to insert the surgical instrument to perform the procedure.. Such surgery is used to treat a broad range of injuries in the joint. Chip fracture removal is a procedure that is particularly commonly in both young Warmbloods with developmental disease and racehorses working at high speeds. A small chip fracture is something that can cause persistent irritation in the joint, as well as arthritis, if left untreated and is best removed immediately so that no further damage is created. The surgeon can easily go into the joint, remove the ...
Indias largest Minimally Invasive Cardiac Surgery program and worlds largest MICS CABG program. Unmatched outcomes, quick recovery, painless.