Ever since the birth of surgery to treat patients, the search for less invasive methods has been a part of the surgeon’s quest. With the development of modern medicine, the results of this exploration have been summarized in a technical term – “minimally invasive”, which is a technique that causes only minimal trauma to the patient during the surgical treatment and leaves only a small wound after the operation, and is a technological achievement compared to traditional surgery. Minimally invasive is not precisely defined, but it is undoubtedly a revolutionary progress compared to traditional surgery. It is formed because of the progress of the whole medical model, and it is regarded as one of the directions of surgical development in the 21st century, with four main characteristics: small incision, small trauma, fast recovery and less pain. At present, the concept of “minimally invasive” has penetrated into various fields of surgery, such as brain surgery, urology and orthopedics, and there are various surgical methods and instruments, such as endoscopy, interventional methods and microsurgery. However, for cardiac surgery, minimally invasive techniques are more difficult to achieve. At present, the application of thoracoscopic techniques in cardiac surgery is limited, which is not only time-consuming and costly, but also controversial in terms of safety, and its future is not yet known, while the premise of cardiac surgery technology is first of all safe and reliable. Coronary artery bypass surgery is required when the diagnosis of coronary artery disease is clear and the indication for surgery is met. The annual volume of cardiovascular surgery is nearly 1500, and the volume of coronary artery bypass surgery has been increasing year by year, and now it has stabilized at more than 300 units per year. Routine bypass surgery with more than 3 reconstructed bridges requires a longer section of the saphenous vein. The conventional method of saphenous vein removal is long and traumatic, and the full suture after removal affects the local tissue blood flow, which may lead to poor healing of the incision and swelling of the lower limbs with lymphatic flow obstruction, delaying the postoperative recovery of patients, prolonging the postoperative hospital stay, and increasing the hospital cost. The thoracoscopic removal of the saphenous vein requires special equipment, and the CO2 airflow and equipment cause great damage to the saphenous vein, and the branch avulsion also causes greater damage, increasing the additional cost by more than 10,000 RMB. At present, the additional cost is not in line with the actual situation due to the low reimbursement ratio of the New Agricultural Cooperative and the limitation of medical insurance. In order to achieve aesthetic and minimally invasive results without increasing the cost, minimally invasive extraction of the bridge vessels under direct vision provides an economical and reliable method. We used multiple transverse incisions of approximately 2 cm in length, exposed with a long narrow pulling hook, and segmental freeing of the saphenous vein and radial artery under laryngoscopic or headlamp illumination, with blunt separation along the SV or radial artery alignment within its fascial sheath, combined with blinded finger probing for freeing and taking the full-length saphenous vein or radial artery as a spare bridge vessel. The radial artery can be taken only if the Alan test is negative before surgery, and the saphenous vein can be used to reconstruct the radial artery if necessary. This technique is called the “hole-punching method”. Since August 2012, this technique has been applied to more than 30 patients who underwent CABG, including 3 cases of radial artery extraction and 1 case of radial artery reconstruction. The saphenous vein taken is mostly the upper section, compared with the traditional taking of the lower section of the saphenous vein, its inner membrane is thick, the inner diameter is coarse, it is not easy to bleed after suturing, and the flow of the bridge vessel is large; multiple small incisions in the lower extremity, especially the transverse incision, it is easy to find the saphenous vein, the suturing is simple, the postoperative recovery is fast, swelling of the lower extremity is rare, and the transverse incision is in line with the skin pattern, the postoperative aesthetics, the patient does not feel the skin tight wrinkles, and the knee joint movement is not affected; the flow of the bridge of the radial artery is large The radial artery bridge has a high flow rate, a high long-term patency rate, and the use of the saphenous vein to reconstruct the radial artery does not affect the blood supply to the upper extremity. All patients underwent the surgery smoothly, and the postoperative activities of the limb with the saphenous vein and radial artery were not affected, and there were no subcutaneous hematoma or incisional healing adverse events, and only three cases had short-term postoperative lower limb swelling. This technique has many advantages over minimally invasive techniques such as thoracoscopy, which are currently being carried out: (1) compared to thoracoscopic techniques, the surgical field of view is completely revealed, and the operation can be performed under direct vision, which is in line with the operating habits of surgeons and is highly controllable, and most of the operations of conventional surgery can be completed. (2) Minimally invasive relying on conventional surgical instruments can be achieved, without the need to purchase additional expensive lumpectomy equipment, while not increasing consumables, more economical than lumpectomy to take blood vessels, and because of direct vision to take than lumpectomy CO2 high-pressure airflow on the vascular tissue damage is small; (3) the technology in essence the fundamental surgical methods, purposes, effects have not changed, no special equipment and consumables, the technical threshold is low, easy to physicians at all levels, hospitals at all levels It is easy to promote and apply at all levels of physicians and hospitals. The technique has been applied to routine surgery at Hartford Medical Center in the United States, and a preliminary technical concept has been formed. For example, valve disease, precordial disease, and aortic surgery can all be performed under direct vision minimally invasive techniques. Because the implementation of this technique depends mainly on further improvement of existing conventional surgical instruments and surgical skills and patience, it does not necessarily require special and expensive equipment like lumpectomy and interventional surgery, or even any additional consumables, and is therefore suitable for hospitals at all levels. The concept of this technique is being gradually explored and improved abroad, but is not yet involved in China. In conclusion, direct minimally invasive surgery is a new minimally invasive surgical technique worth recommending and promoting because of its small incision, good exposure, operability, fast postoperative recovery, beautiful incision, reduced hospitalization time, no additional surgical costs, labor and material savings, and meeting the requirements of minimally invasive surgery.