To get their scalpels onto an ailing heart, surgeons usually have to crack open a patient's rib cage-not a pretty sight, nor a procedure helpful to the healing process. That standard method may change soon: Using experimental robotic surgical instruments, physicians in France and Germany have performed a series of ground-breaking heart operations through dime-sized incisions, without any rib cracking at all. The advances culminated in late June when Alain Carpentier and Didier Loulmet of Broussais Hospital in Paris used the new techniques to perform a coronary artery bypass graft.

Minimally invasive surgery-which leaves patients with tiny scars and little post-operative pain-is already commonplace for procedures such as removing gallbladders. But more complex operations, such as heart surgery, have resisted minimally invasive methods, which generally require physicians to operate using awkward chopstick-like instruments. The French team of physicians was able to push the envelope thanks to a new system that gives joystick-wielding surgeons precise control over dexterous surgical instruments.