Foreword
The increasing adoption of thoracoscopy in cardiac surgery has fueled much excitement in the medical community and led to a growing number of surgeons，to explore its application in a various clinical situations.Supporting data from clinical trials indicate that thoracoscopic cardiac surgery（TCS）is capable of achieving a minimal degree of invasiveness on the premise of attaining the same safety and efficacy as conventional cardiac surgery. As a result，surgeons are now able to effectively preserve the integrity of the patient’s thorax，lessen postsurgical pain，reduce hospitalization time，and improve the quality of life and alleviate psychological stress of the surgery.
TCS can be generally designated into one of two broad categories of either thoracoscopic assisted or totally thoracoscopic cardiac surgery. Thoracoscopic assisted cardiac surgery is a more mature and ubiquitously adopted techniques via small incisions. While totally thoracoscopic operation is a variant of robotic-assisted minimally invasive surgery，which recently has gained strong interest. To understand this emerging trend，it is pertinent to note that totally thoracoscopic minimally invasive surgery is deemed more appealing with its reduced surgical trauma，pain and recovery times. Despite the advantages of this technique and patient’s preference，the prevalence of totally thoracoscopic surgery remains low. The low adaption rate is multifactorial including the complexity and cost of the robot and disposables and relatively steep learning curve. Hence，the pursuit of to perfect totally thoracoscopic cardiac surgery is viewed as the holy grail by the community of cardiac surgeons.
In response，present state-of-the-art concentrates on port-access TCS techniques to attain desired attributes of totally endoscopic minimally invasive surgery. Dr. Ma Zengshan，tenured Professor of Cardiac Surgery from the Qilu Hospital of Shandong University and his team，extended the closed chest techniques through conventional TCS procedures by ingeniously utilizing a triplet of ports，allowing thoracoscopic visualization to the operating surgeon. This novel extension is termed the TriPort Chest Thoracoscopic Technique，also known as the MATechnique（MAT）in clinical literature. This application successfully overcomes the drawbacks of small-incisionbased cardiac surgery with its limited field of vision，procedural challenges，considerable amount of trauma，postsurgical pain while circumventing the shortcomings of robotically-assisted heart surgery.
The MAT is highly versatile and surgeon-friendly in maintaining a coterminous field of vision as conventional cardiac surgery. The modular nature of thoracoscopic procedure allows easy adaptability and inplementaton. These advances are the culmination of more than a decade of clinical breakthroughs pioneered by Dr. Ma and his team.During his practice as a physician and surgeon，he demonstrated exceptional clinical judgment and skill. His published works in various peer-reviewed national and international academic journals have received high and universal praises. A variety of complex diseases such coronary artery bypass grafting，congenital heart disease，atrial fibrillation ablation and valvular corrective surgery can be performed by the MAT. With further technical refinements and development of enabling technology，I am convinced that MAT will further advance the field of closed chest minimally cardiac surgery and will gain popularity.
This book hereby provides a comprehensive review of thoracoscopic technologies currently being utilized in cardiovascular surgery. With a combination of detailed photographic media，concise narrative and clinical data summarize the key MAT and TCS concepts. The book is written so brilliantly in providing a strong conceptual foundation and insightful practical tips and tricks will interest all readers. A meaningful and positive impact in the surgical treatment of cardiovascular disease will be realized with wider adaptation of MAT. I strongly believe that this groundbreaking publication will serve as a go-to reference to those who want to take on the surgical challenges of the 21st century and tap into the boundless opportunities now presented by thoracoscopic surgery.
