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New Trend in the Periareolar Minimally Invasive Approach: The PAMI Technique

Tuesday, September 5, 2023

El Adel M, Alaa Nady M. New Trend in the Periareolar Minimally Invasive Approach: The PAMI Technique. September 2023. doi:10.25373/ctsnet.24085098

This video demonstrates a new modification to the periareolar approach, periareolar minimally invasive technique (PAMI).

The periareolar approach has been the preferred technique in Brazil since 2006, hence named the Brazilian technique. It is a video-assisted minithoracotomy through a skin incision along the lower ridge of the areola (1). However, in this modified technique, the incision is made along the upper edge of the areola, and the chest is entered via the third intercostal space, compared to entering through the fourth intercostal space in the Brazilian technique.

This new modification to the periareolar approach is performed by one surgeon in this center and has an acronym of "PAMI" referring to periareolar minimally invasive technique.

A short-term result of the authors’ randomized controlled trial (PAMI trial) for this technique was published in The Cardiothoracic Surgeon Journal illustrating, in detail, how to perform it (2). In this video, one of these cases is described in a step-by-step fashion showing how the authors perform the PAMI technique.


  1. Poffo R, Pope RB, Selbach RA, Mokross CA, Fukuti F, Silva Júnior I, et al. Video-assisted cardiac surgery: results from a pioneer project in Brazil. Rev Bras Cir Cardiovasc. 2009;24(3):318-26.
  2. El Adel M, Nady MA, Amin A, Khairy M. A randomized controlled trial (PAMI trial) on our new trend periareolar minimally invasive (PAMI) technique versus inframammary approach for minimally invasive cardiac surgery. The Cardiothoracic Surgeon. 2022;30(1):29.


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