We developed a simulation-enhanced, stepwise educational strategy for MICS-CABG under direct supervision. In this study, we evaluated the feasibility, safety, and early clinical outcomes of this training program in consecutive trainee-performed MICS-CABG cases.

A structured, simulation-enhanced, stepwise educational strategy was used for MICS-CABG training. Trainees first developed basic minimally invasive surgical skills using simulation training and learned internal thoracic artery harvesting with long-shaft instruments and distal coronary anastomosis from the patient’s left side during conventional sternotomy off-pump coronary artery bypass grafting (OPCAB)[4]. Training then progressed stepwise to cardiac exposure and mobilization, proximal anastomosis[5], and performing MICS-CABG under direct supervision.

Twenty-one consecutive MICS-CABG procedures performed by two trainee surgeons were analyzed.

Mean age was 73 ± 10 years, and 71% had triple-vessel disease [Table 1].

An off-pump strategy was used in 95% of cases, and BITA was used in 48%. Mean operative time was 295 ± 89 min, with one on-pump conversion (5%) and no conversion to sternotomy [Table 2].

Early outcomes were favorable, with no mortality, cerebrovascular events, surgical site infection, or repeat revascularization. Postoperative computed tomography angiography demonstrated an early graft patency of 98% (49/50). Median postoperative hospital stay was 13 (9–18) days [Table 3].