Minimally Invasive Coronary Surgery: How Should It Be Defined?

The earliest report of a minimally invasive coronary artery bypass grafting (CABG) concept in the current era was in 1994, Benetti and Ballester from Argentina described the first left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis through a left anterolateral minithoracotomy.1 Ever since, the technique has been adopted and modified by different institutions and with robotic assistance, leading to a wide spectrum of procedures all included in the term minimally invasive (Fig. 1). This wide range of approaches makes it difficult to perform clinical research and evaluate the benefits in multicenter clinical trials. On the other hand, some of the variable approaches may raise the question: what should still be considered minimally invasive? As clear definitions and guidelines are lacking, we briefly describe the most frequently used techniques and comment on their invasiveness.