Abstract: Background: The rate of coronary artery bypass grafting (CABG) procedures decreased generally over the past years while the relative number of off-pump coronary artery bypass grafting (OPCAB) procedures remained stable. OPCAB can be performed in different ways also using a minimally invasive direct approach (MIDCAB). This technique consists usually of the approach through the left anterior small thoracotomy (LAST) and is in principle limited for single LAD revascularization only. Lower mini-sternotomy (LOMS) is an optimization of the minimal-invasive approach permitting the harvest of both internal thoracic arteries (ITA) as well as excellent exposure and immobilization of the left and right coronary arteries.
Methods: Between January 2016 and June 2017 LOMS was performed in 31 patients to achieve access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery, diagonal branches, and right coronary artery for off-pump, all-arterial, aortic no-touch revascularization. Postoperative pain intensity was assessed on a daily basis for 7 days and patients were followed prospectively after operation at our outpatient clinic on a monthly basis in order to assess the incidence of complications.
Results: The mean operative time was 163 ± 49 minutes (range 119 to 260 minutes). The mean length of the skin incision was 7.4 ± 1.3 cm (range 6 to 11 cm). Neither hemodynamic changes nor transient S-T segment changes on the ECG occurred during the operation. In most patients, recovery was rapid and uneventful. No hospital death or morbidity was observed. No blood transfusion was required perioperatively. There were no perioperative neurological cognitive dysfunction events. Maximal pain levels were registered on postoperative day 2 or 3, and pain had abated in most patients on day 5. At follow-up, all patients were in New York Heart Association class I.
Conclusions: Despite more demanding surgical technique than with full-sternotomy OPCAB, our experience demonstrates that the LOMS for MIDCAB is a technically feasible procedure for myocardial revascularization. Not only the LAD and its branches but also the RCA and can be used safely with very good procedural outcomes.

Abstract: Bone cutting is a fundamental aspect of numerous surgical procedures in orthopedics, dentistry, and neurosurgery, particularly for implantation and repair. Over the past few decades, innovative bone surgical techniques have been developed to minimize invasiveness and enable more precise and delicate cuts. In minimally invasive surgery (MIS), controlled bone resection is critical to avoid damage to the bone itself or surrounding delicate tissues. Traditional tools such as electric saws, manual chisels, gouges, burrs, and high-speed drills are often associated with significant limitations, including imprecise cuts, excessive cutting forces, elevated temperatures at the cutting site, bone fractures, and a heightened risk of trauma to adjacent tissues. These issues can hinder osseointegration and significantly delay healing. Furthermore, intraoperative and postoperative complications arising from these tools place a substantial burden on healthcare systems, increasing patient stress and financial strain on hospitals. The development and adoption of advanced, safe, and efficient bone cutting technologies are essential, particularly in orthopedics and craniotomy. Such innovations can greatly enhance surgical outcomes, reduce complications, and alleviate the overall burden on healthcare systems.
A novel surgical technique called ultrasonic cutting (UC) involves applying high-frequency vibrations to the cutting tool in the direction of the cut. UC has emerged as a promising alternative to conventional tools for minimally invasive surgery due to its superior precision, safety, and efficiency. Experimental studies using ultrasonic tools have shown that, with the right frequency and amplitude, the cutting process generates lower forces and temperatures. Vibrational drilling (VD) or ultrasonically assisted drilling (UAD) has also demonstrated significant advantages over conventional drilling (CD). It requires less drilling force, causes less delamination around the hole, and produces fewer microcracks. Frequencies below 15 kHz in VD are particularly effective for safe and efficient bone drilling, as they minimize force, temperature, and necrosis. Conversely, worn drills have been found to cause greater biological damage to bone than sharp drills under similar conditions. With optimal vibrational frequency and drilling parameters, UAD can significantly reduce structural and biological damage to bone compared to CD. To integrate this innovative technique into orthopedic and neurosurgery, it is essential to develop, evaluate, and provide surgeons with specialized bone-cutting tools designed to meet these advanced requirements.
In addition to the research study highlighted above, participants will be introduced to ongoing/proposed research projects in Sultan Qaboos University in collaboration with international partners.
1. Design and development of hand-held bone surgical drill with ultrasonic assistance
2. Modeling Blood-Brain Barrier (BBB)
3. Design, development & testing of artificial cardiac circulatory system for performance evaluation of cardiovascular devices
4. Experimental and numerical investigation on the effect of chemotherapy agents on arterial stiffness