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Minimally Invasive Heart Surgery

Minimally invasive heart surgery (also called keyhole surgery) is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches instead of the 6- to 8-inch incision required for traditional surgery.

Robotically Assisted Heart Surgery

Robotically assisted heart surgery, also called closed-chest heart surgery, is a type of minimally invasive surgery. The cardiac surgeon uses a specially designed computer console to control surgical instruments on thin robotic arms. Robotically assisted technology allows surgeons to perform certain types of complex heart surgeries with smaller incisions and precise motion control, offering patients excellent outcomes. In robotic surgery, small incisions—less than 2 inches—are used, compared with the 3- to 4- inch incision used in traditional minimally invasive heart surgery.

Benefits of Minimally Invasive Surgical Techniques

The benefits of minimally invasive and robotic heart surgery techniques include:

Small Incision Heart Surgery

  • Small incisions
  • Small scars

Other possible benefits may include:

  • Shorter hospital stay after surgery: The average stay is 3 to 5 days after minimally invasive surgery, while the average stay after traditional heart surgery is 7 to 10 days
  • Low risk of infection
  • Low risk of bleeding and blood transfusion 
  • Shorter recovery time and faster return to normal activities/work: The average recovery time after minimally invasive surgery is 1 to 4 weeks, while the average recovery time after traditional heart surgery is 6 to 8 weeks. The recovery time and return to regular activities is shorter for patients who undergo robotically assisted heart surgery.
  • Division of the breastbone is not needed for robotically assisted heart surgery.

Important Note: Not everyone is a candidate for these surgical techniques. Your surgeon will review the results of your diagnostic tests before your scheduled procedure to determine if you are a candidate for minimally invasive surgery. The surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques versus traditional surgery techniques.

Types of Minimally Invasive Heart Surgeries

Minimally Invasive Valve Surgery

Valve surgeries, including valve repairs and valve replacements, are the most common type of minimally invasive surgery, accounting for 87 percent of all minimally invasive cardiac surgeries performed at Cleveland Clinic.

Minimally Invasive CABG Surgery

Minimally invasive direct coronary artery bypass graft (MIDCABG) surgery is an option for some patients who require a left internal mammary artery bypass graft to the left anterior descending artery.

Saphenous (leg) vein harvest also may be performed using small incisions.

Several techniques for minimally invasive CABG surgery are being explored at Cleveland Clinic, including surgeries performed on a beating (off-pump) or non-beating (on-pump) heart.

Off-pump/beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. A medication may be given to slow the heart during surgery, but the heart keeps beating during the procedure. This type of surgery may be an option for patients with single-vessel disease (such as disease of the left anterior descending artery or right coronary artery).

Traditionally, CABG surgery is performed using a heart-lung bypass machine. This machine allows the heart’s beating to be stopped, so the surgeon can operate on a surface that is blood-free and still. The heart-lung bypass machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.

During off-pump/beating heart surgery, the heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Types of Robotically Assisted Heart Surgeries

Robotically Assisted Valve Surgery

Robotically assisted mitral valve repair can be used to treat mitral valve regurgitation. Tricuspid valve surgery also can be performed using the robotically assisted surgical technique.

Robotically Assisted Bypass Surgery

Robotically assisted CABG surgery can be performed without opening the sternum (breastbone). Robotically assisted CABG surgery also can be performed “off pump,” which means the surgery can be performed on a beating heart, without using the heart-lung bypass machine.

Robotically Assisted ASD and PFO Repair

Robotically assisted atrial septal defect (ASD) and patent foramen ovale (PFO) repair surgeries can be performed using a robotically assisted approach. Robotic instruments are used to harvest a small patch of pericardial tissue (the sac that surrounds the heart). The patch is then sutured (sewn) over the defect.

Robotically Assisted Removal of Cardiac Tumors

The most common benign tumor of the heart is a myxoma, which most frequently occurs in the left atrium. This type of tumor increases the risk of stroke. Removal of these tumors almost always cures the problem and greatly reduces the risk of stroke. During the robotically assisted tumor removal procedure, the surgeon’s hands control the movement and placement of the endoscopic instruments through small incisions in the chest wall, and the instruments are used to remove the tumor.

Robotically assisted heart surgery is performed through a small working incision and three small incisions (ports) that are made in the spaces between the ribs (see image to the right). The surgical instruments (attached to the robotic arms) and one tiny camera are placed through these ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the movement and placement of the surgical instruments to perform the procedure.

During robotically assisted surgery, the sternum (breastbone) does not need to be opened to perform the procedure. Depending on the technique, the surgeon may choose to perform surgery on a “beating heart,” in which case the patient is not placed on the heart-lung bypass machine (this is called“off-pump” surgery).

In comparison, traditional valve and CABG surgery involve using the heart-lung bypass machine to circulate the patient's oxygenated blood during surgery and stopping the heart in order to stabilize the blood vessels; creating a 6- to 8-inch incision through the sternum; and spreading the ribs to view the heart.

Robotically Assisted Device Implant for Heart Failure

During the robotically assisted biventricular pacemaker or defibrillator implant procedure, the surgeon’s hands control the movement and placement of the endoscopic instruments through small incisions in the chest wall. This surgical technique can be used to place leads on the surface of the left ventricle. The leads then are attached to the biventricular device (defibrillator or pacemaker) to “resynchronize” the heartbeat and improve heart failure symptoms.

Robotically Assisted Atrial Fibrillation Surgery

During the robotically assisted ablation procedure for atrial fibrillation (an irregular heart rhythm that begins in the upper chambers of the heart), the surgeon’s hands control the movement and placement of the endoscopic instruments to open the pericardium (thin sac that surrounds the heart). The instruments are used to precisely place the catheter for ablation, in which energy is applied to correct the abnormal heart rhythm. 

Who Is a Candidate for Minimally Invasive or Robotic Surgery?

Your surgeon will review the results of your diagnostic tests before your scheduled surgery to determine if you are a candidate for a minimally invasive or robotic surgery technique. The surgical team will carefully compare the advantages and disadvantages of these techniques with those of traditional surgery.

The type of treatment recommended for your condition depends on several factors, including the type and severity of heart disease, age, medical history and lifestyle.

How Will I Feel After Surgery?

You may feel some discomfort at the incision site after surgery. You can take medications to help relieve this discomfort. Ask your doctor which medication you should take for pain relief. If you have discomfort in your chest that is similar to the symptoms you had before your surgery, call your doctor.


Patients who have minimally invasive or robotic surgery may be able to go home 2 to 5 days after surgery. Your healthcare team will follow your progress and help you recover as quickly as possible.

Your healthcare team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

Recovery after minimally invasive heart surgery

In general, you may be able to return to work (if you have a sedentary job), resume driving and participate in most non-strenuous activities within 1 to 4 weeks after traditional minimally invasive heart surgery. You can resume heavy lifting and other more strenuous activities within 5 to 8 weeks after surgery. Your healthcare team will provide specific guidelines based on your rate of recovery.

Recovery after robotically assisted heart surgery

The recovery time after robotically assisted heart surgery is shorter than traditional minimally invasive heart surgery. Most patients can resume normal activities, drive and return to work as soon as they feel up to it—usually within 2 to four weeks after surgery. Your healthcare team will provide specific guidelines based on your rate of recovery.

Recovery for all patients after heart surgery

To maintain your cardiovascular health after surgery, we strongly encourage you to make lifestyle changes and take your medications as prescribed. Heart-healthy lifestyle changes that are important to your recovery include:

  • Quitting smoking
  • Treating high cholesterol
  • Managing high blood pressure and diabetes
  • Exercising regularly
  • Maintaining a healthy weight
  • Eating a heart-healthy diet
  • Participating in a cardiac rehabilitation program, as recommended
  • Following up with your doctor for regular visits

For More Information

Cleveland Clinic’s heart surgeons are specialty trained in all types of heart surgery from traditional approaches to the latest minimally invasive options.

Reviewed: 05/11

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2015 Cleveland Clinic. All rights reserved.

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