Photograph courtesy St. Elizabeth
Heart surgery is rapidly changing and St. Elizabeth Healthcare is leading the way. Using a state-of-the-art 3D 4K endoscope to provide a high-definition, magnified view of the heart allows St. Elizabeth cardiothoracic surgeon Mario Castillo-Sang, M.D., to perform truly minimally invasive surgeries with a new level of precision. St. Elizabeth is one of only two health systems in the country to have this technology and Castillo-Sang is one of a very small group of surgeons in the U.S. who have mastered totally endoscopic surgical techniques. Conditions that previously could only be treated through a traditional sternotomy, which opens the chest, can now be treated with smaller incisions and the use of cameras. The clarity of the imaging is so sharp and clear, Castillo-Sang says, “it almost feels like cheating.”
3D technology is changing the game
As you might imagine, it’s not easy to maneuver a 12-inch instrument with a needle at the end during surgery. It takes practice. The 3D 4K endoscopic technology makes it easier for a surgeon to measure distances visually while maintaining the haptic feedback in the hands that tissues transmit through the instruments, all while remaining next to the patient undergoing a complex open-heart operation. “This makes for a more efficient and more effective operation,” adds Castillo-Sang. It also means fewer surgical adjustments, less time under anesthesia, and smoother recoveries for patients.
Expanding what’s possible with totally endoscopic cardiac surgery (TECS)
Photograph courtesy St. Elizabeth
Totally endoscopic cardiac surgery allows St. Elizabeth surgeons to perform major procedures through incisions about the size of a coin. TECS is often called the Swiss Army knife of heart surgery because it can treat everything from valve disease to cardiac tumors—without opening the chest. The new 3D 4K technology optimizes surgery even further, providing a more precise way to treat conditions like mitral annular calcification (MAC).
“MAC turns out to [be] very common in our region,” says Castillo-Sang. The condition typically appears in patients age 70 or older. It occurs when calcium starts to deposit on the mitral valve, which controls blood flow between the left atrium and the left ventricle. It’s similar to how rust spreads on a car door. At first, it’s small and localized, but over time the rust can spread and compromise the entire door. If you try to break off the rust without proper care, you might destroy the door entirely. “The same [principle] applies to MAC,” says Castillo-Sang. “Removing it aimlessly may result in the heart suffering a perforation which is nearly [always] fatal.” Heart surgeons can address MAC using ultrasonic energy to pulverize the calcium, but that has typically required a high-risk open-chest procedure. Using TECS revolutionizes patient care and improves surgical success.
Many more patients are eligible for treatment
Photograph courtesy St. Elizabeth
For patients with severe or complex medical conditions, a sternotomy is out of the question. Castillo-Sang says many of the endoscopic surgeries performed at St. Elizabeth are for patients previously turned down by other medical centers. “We have successfully operated on patients with prior open-heart surgery, severe calcium on the mitral valve, cardiogenic shock, and other severe accompanying medical problems,” he says. “We have also repaired mitral valves endoscopically in patients that would have otherwise been replaced at other facilities.”
As technology evolves, Castillo-Sang predicts that more and more surgeons will move away from the sternotomy and opt for imaging platforms with 3D and virtual reality components. Ultimately, though, it’s the human behind the tools that matters most, he says. “Surgery is still much of an art. Two people can play the exact same notes on a violin, a piano, or a guitar and one produces music and the other may sound mechanical. After all, electronics malfunction, endoscopes can get blurry,” he says. “It is the surgeon and the surgical team that will bring excellent results for patients. We are working on helping the future generation of endoscopic surgeons at St. Elizabeth.”
This September, St. Elizabeth Healthcare is hosting the 2025 Endoscopic Cardiac Surgeons Club annual meeting at the St. Elizabeth Training and Education Center (SETEC) in Erlanger. This event brings the world’s leading experts in minimally invasive heart surgery to Northern Kentucky to learn more about the latest innovations in endoscopic cardiac surgery.
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