Abstract
The maze procedure is a therapeutic option for selected patients with standalone atrial fibrillation. Advances in ablation technology have made feasible a range of minimally invasive approaches, avoiding some of the morbidity and technical complexities of the classic maze procedure. Further, combining surgical and transvenous techniques allows a staged approach. We describe the technical aspects of the surgical portion of a staged hybrid approach developed by our group, using a bilateral thoracoscopic-assisted mini-thoracotomy approach with bipolar radiofrequency ablation. In our practice, we have found the minimally invasive bilateral thoracoscopic maze to be a safe and efficacious part of a staged strategy for the treatment of lone atrial fibrillation.