A video assisted thoracoscopic transmyocardial revascularization (TMR) surgical method includes making at least two spaced incision ports between the ribs of a patient proximate the patient's heart; inserting through one of the ports a thoracoscopic TMR handpiece assembly for creating a channel through the heart wall; inserting through the other incision port a thoracoscope connected to a video display system; viewing the heart of the patient through the video display system and positioning the handpiece assembly relative to the heart; and actuating the handpiece assembly to create a channel through the wall of the patient's heart.