Minimally Invasive Coronary Artery Bypass Surgery


MICS CABG or Keyhole heart bypass surgery is also called minimally invasive coronary bypass surgery. It may also be called a minimally invasive CABG or Keyhole CABG. It is the technique of minimally invasive bypass of blocked blood vessels in the heart. The operation is done through a small cut on the left side of the chest. It is a relatively new but advanced technique of performing coronary bypass (CABG) for coronary artery disease. This cut is placed just under the nipple. The chest entered between the ribs without cutting any bones and by splitting the muscle. Similar to a regular heart surgery the operation is performed using all arteries or a combination of arteries and veins removed from the leg. The vessel from the leg in this operation is also removed endoscopically (EVH) without cutting the skin over the leg. Highly advanced instrumentation and advanced techniques allow for the operation to be performed very safely.

Advantages of MICS CABG(Keyhole Bypass)

First and foremost is the fact that no bones are cut. This has several advantages in reducing pain, retaining function and a positive effect on breathing. Unlike traditional heart surgery return to normal life including driving or other activities is not disrupted and can be started almost immediately. Second, blood loss is almost negligible eliminating blood transfusion in most and eliminating blood borne infection. Third, all infections are reduced whether it be wound infections or post surgical lung infection. This makes the procedure ideal in diabetics and older patients who have poor resistance to infection. Fourth, the incision is so cosmetic and measures just 2 – 3 inches that it’s practically impossible to tell that a heart operation is performed.


Patients suitable for MICS CABG

MICS CABG – Thinking Forward…

MICS is the future of heart surgery. Its safe, effective and delivers outstanding patient comfort and outcomes. It’s the best thing to happen to heart surgery in the last two decades. 

What makes us leaders in MICS CABG?

There is a reason we are leaders. We are the single largest centre for MICS CABG in the world and the worlds largest experience as well. We are one of 8 centres for a global trial on MICS CABG. You can read about it here.
There’s more, we use the latest technology to make surgery safe for you. All conduits for bypass are harvested endoscopically or robotically. This means MICS CABG is truly minimally invasive. We conserve your blood with state of the art equipment so that no foreign blood is given to you. Most importantly, every bypass graft is checked with special instruments to make sure its functioning well before we leave the OT. This quality assurance is what makes us leaders and our outcomes superior. Read more about verifying graft patency here.

Video of Transit Time Flow Doppler

Not suitable for Keyhole Bypass Surgery?

That’s a lie. 70% of our patients are suitable for MICS CABG. It’s exactly why, we are the leaders. Meet us and we will prove them wrong almost always.

A highly skilled team coupled with state of the art technology offers unmatched patient outcomes

We rethought everything that mattered....

Advanced instrumentation plays a key role in the exceptional outcomes that MICAS offers

Rethinking coronary bypass...

We perfected the MICS CABG procedure much before anyone even dreamed of it in the country! With the largest series and the best outcomes, we are true leaders in minimally invasive heart surgery.

Our outcomes are unmatched!


Reduction in Pain


Reduced Blood Transfusion

Days in Hospital

Amazing Result

The Challenge

For over four decades coronary bypass surgery or CABG as its commonly referred to, had just one goal. The goal was to restore the heart’s blood supply effectively and in a long lasting manner. There was one way to do it. Cut open the breast bone or sternum into two halves, causing significant pain and slow recovery, essentially scarring the patient for life. Nothing changed all these years. But now, if we could do the same operation, equally effectively without cutting any bone. This was the challenge!

The Solution

Imagine heart surgery with no bones to be cut, with little or no pain, with just 3 days in the hospital and the ability to return to normal life as early as a week. Minimally invasive CABG or minimally invasive bypass also called MICS CABG or MICAS is just that solution. Its the most advanced method of bypassing blocked blood vessels in your heart without breaking your chest. It’s the solution that everyone was waiting for both surgeon and patient. It offers outcomes that are unmatched.

Listen to A Patient’s Experience

Listen to more real patient experiences. More than 2000 patients have benefitted from our innovative surgical techniques since 2008.

Recover in days, not months!

We are often asked by patients and families on the differences in recovery between open bypass surgery and MICS CABG. While it may not always be possible to measure each difference, one aspect stands out. Those who have undergone MICS CABG seem mentally stronger and more confident during their recovery immediately after the procedure. We also note that this feeling of wellness seems to persist several months later after the procedure. We believe that this is probably because of less psychological trauma associated with MICS CABG surgery. We have put up a set of differences in recovery between open and MICS CABG. This should help patients and their families to know what to expect before and after surgery.


  1. Surgical wound heals in ten days
  2. Fit to drive a car or motorcycle in a week
  3. No restriction to carry weights
  4. No restrictions on social visits
  5. Can resume normal life activities in ten days
  6. Active lifestyle is encouraged
  7. No risk of bone infection as no bones are cut

Open CABG (Sternotomy)

  1. Surgical wound heals over three months as the bone is cut.
  2. Should not drive a car or motorcycle for 2 to 3 months (until bone healing is complete)
  3. Unsafe to carry weights
  4. Social visits unsafe until healing is complete (risk of infection)
  5. Resume normal activity in 2 months
  6. Active lifestyle restricted to walking.
  7. Upper body exercises/cycling etc discouraged until bone heals
  8. Deep wound infection (bone) can be life threatening

MICS CABG Suits 70% Of Patients

Rapid Recovery

Recovery after MICAS is rapid in all age groups. In those who are otherwise healthy, return to normal life can be expected as early as 10 days. Those who are significantly ill can still expect to return to normalcy as early as 3 weeks.

Shorter Hospitalisation

Significantly shortened hospitalization is an important benefit of MICAS. Post surgery 90% of patients are back home on day 3. This has several advantages in reducing health care costs, reducing hospital acquired infections and has a positive impact on patients psychology.

Near Zero Infection

The 2 inch incision heals rapidly and infection rarely if ever occurs. Diabetics undergoing surgery particularly benefit as they have a greater risk of  impaired healing. A near zero% infection is hard to imagine but true.
MICS CABG 3 months

MICAS is the new ‘state of the art’ for CABG. What was once

considered impossible is now possible

How is MICAS performed?

MICAS or Minimally Invasive CABG differs from conventional CABG in two ways. It’s important to understand how a traditional CABG is done to differentiate the two. In traditional CABG the chest is cut into by sawing the breast bone or sternum in two pieces. A spreader allows the two halves of the bone to be spread apart allowing access to the heart. The rest of the operation involves sewing the grafts or conduits taken from the leg or other parts of the body to the blocked vessels to bypass them.
In MICAS or MICS CABG several advantages exist over the traditional technique. No bones are cut. The chest is entered through a 2 inch incision on the left side of the chest below the nipple. The heart is accessed between the ribs. A special retractor is used to spread the ribs apart without breaking them. Specialized instrumentation is then used to take down the internal mammary artery (LIMA) which is used to graft the main vessel on the heart or LAD. A specialized stabilizer and positioner are then used to manipulate the heart allowing the surgeon access to the vessels that are deeper down. Once the vessels are accessed the conduits or vessels taken from elsewhere are sewn to the blocked vessels to a healthy area beyond the block.  Very fine sutures with specialized needles that are extremely small (8mm, 0.8 microns) are used to sew. These sutures are half the thickness of the human hair. The surgeon uses magnification (Loupes) to do the operation and this helps him to see what the normal eyes do not. Advanced training in minimally invasive surgery is required to do these operations. As of now only a select few centers have the instrumentation to do these operations. The equipment is expensive and most smaller hospitals cannot afford to buy them. There are hardly a few surgeons with certified training to do these operations. Training is not about visiting a center that does minimal invasive surgery. Its about spending time with experienced surgeons to learn the art and technique in detail.
  • Reduction in Infection 99% 99%
  • Reduction in Analgesic Use 70% 70%
  • Return to Work in 10 days 75% 75%
  • Reduction in Blood Transfusion 70% 70%

The Results Were Amazing

MICAS or MICS CABG offers truly amazing results. Following a triple vessel bypass hospital stay is a mere 2 days. Eighty percent of patients recieve no blood transfusion. Post surgery patients are walking within 24 hours of operation. Pain management is simple with just paracetamol for relief. What could be more surprising if we told you that you could return to your job or to your normal routine as early as a week. Gone are the days of prolonged hospitalization and even longer recovery. MICAS is changing everything about coronary bypass. Meet us, we are the leaders in this part of the world.

Comparing MICS CABG to Open Coronary Bypass


Days in Hospital (MICAS)

Return to Work In Days (MICAS)

The benefits of MICS CABG over Conventional CABG stands out when compared. Practically every parameter that was compared was superior in the MICS CABG group.

Our center is practically the only one in the world that offers post operative angiograms to patients to prove graft patency if they so desire.

Conventional CABG or Coronary Bypass

Days in Hospital (Sternotomy)

Return to Work in Days (Sternotomy)

Watch how multiple bypasses are done by the keyhole technique (MICS CABG)

Understanding the tools behind the technique….

Traditional heart bypass surgery or CABG as it is referred to involves cutting open the chest bone to access the heart. Once the heart is exposed the blocked vessels on the surface of the heart are identified by turning the heart in various positions while it continues to beat. This is referred to as beating heart or Off pump surgery, since a heart lung machine is not used to stop the heart. In MICAS or minimally invasive CABG the same operation is performed with the heart beating. How ever in MICAS since the hand cannot be introduced through the small incision specialized devices are inserted that help in holding the heart at its tip allowing it to be moved to expose the vessels that need to be grafted. Two devices are of importance. One is the Octopus which basically is the device that helps stabilize the part of the heart that has the blocked vessels. The second device is the starfish that helps position the heart to expose the area. These devices although they have funny names, named after sea creatures, actually play a pivotal role in helping the surgeon in operating on the desired areas. They are shaped like these sea creatures and function more or less similarly.

Frequently Asked Questions

These are answers to a few questions that patients frequently ask. You can also visit the FAQ page for more answers. If you have a question that’s not answered and is relevant to this technique or your recovery after this operation, please let us know and we will answer it for you.

Can I drive a car or motorcycle after MICS CABG?
Yes, you can drive a car or motorcycle immediately after a MICS CABG. Since no bones are cut, all kinds of physical activity is allowed after MICS CABG. However it may be prudent to wait until sutures are removed and the wound healed. This should take approximately 10 to 14 days. Its also important to note that there are no restrictions on bending forward after MICS CABG. There are also no restrictions in carrying weight after this operation.
Can all vessels be bypassed in MICS CABG?
Yes, in our experience, all vessels can be bypassed in MICS CABG. The right sided vessels can also be comfortably bypassed in MICS CABG. We routinely perform as many as 5 bypasses in MICS CABG’s. Its possible that you have been told by someone else that your right sided vessels cannot be grafted in the MICS technique. This is untrue and you were told this because they were not adequately trained to do this operation.
How do we know that the operation is complete and all vessels were bypassed?
You can request to have an angiogram done after the operation to confirm all vessels were grafted. Note that if you have kidney dysfunction or long standing diabetes it may be ill advised. It’s best to allow your surgeon to make that decision. We encourage all patients, if safe medically, to undergo an angiogram. We may be the only centre in the world doing so.
What problems should I expect during the recovery period?
Mostly none. Three out of ten patients can have cough and breathing difficulty which is temporary and will disappear in about 10 to 14 days. Wound healing can take upto two weeks and in some diabetics and obese can take longer. The area around the wound can feel tender and sometimes hard during the first few weeks after the operation. This is part of the healing process and is normal. Watery discharge from the wound is sometimes seen particularly in diabetics with poor control of blood sugars. Their is no need to panic but should be brought to the notice of the surgeon or his team.
This addresses two of the questions listed above. First, are all vessels bypassable with the MICS CABG technique? Second, how do we know whether all vessels are bypassed?. Both are valid questions, most surgeons will avoid answering, if not comfortable with this operation. So, we took transparency to a new level. We offer angiograms to patients routinely to demonstrate the vessels that have been bypassed and in our book, every vessel can be bypassed. Irrespective of where its located on the heart!   The evidence is up there. This is just one of more than a hundred angiograms that have been done.

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