A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the work device such as for drug delivery. In a second embodiment a rigid endoscope with a viewing channel has an introducer member that is slidably disposed and detachable from the viewing channel and has a transparent convex distal tip which provides non-articulation at the distal end. This introducer member can also be used in conjunction with the first embodiment where the catheter shaft requires non-articulation. Both types of visualization scopes include a working channel in which the working device can translationally egress from the scope's distal end. Additionally, the rigid introducer member can be modified to include a movable transparent rotatable member design for varying the direction which the working devices egresses the apparatus' distal end. The preferred surgical procedure is transmyocardial revascularization and the preferred working device is an optical fiber element that is translatable from the distal end of the apparatus during the procedure. The working device can optionally include a flexible piercing needle with an internal lumen which allows translation of a working device such as an optical fiber or act as a conduit for drug delivery.