We report a patient in whom coronary artery bypass grafting with the left internal mammary artery to the left anterior descending coronary artery and laser transmyocardial revascularization were simultaneously performed through a left small thoracotomy. The patient recovered uneventfully and 9 months following surgery he is free of angina and has increased effort tolerance. This case underlines the feasibility of combining these two minimally invasive procedures through the same approach in selected patients.