Minimally Invasive Cardiac Surgery
Improving patient comfort by reducing pain is one of the concerns of a cardiac surgeon. Making the procedure less invasive is one of the ways by which surgeons aim to achieve this.
Minimally invasive surgery is performed through a small incision, often using specialized surgical instruments. The incision is about three to four inches instead of the six to eight inch incision required for traditional surgery.
Types of minimally invasive cardiovascular surgeries include:
- Valve surgery
- Coronary artery bypasses graft (CABG) surgery
- Epicardia lead placement – Placement of leads for biventricular pacemakers (cardiac resynchronization therapy)
- Atrial fibrillation
Minimally invasive direct coronary artery bypass graft (MID CABG) – It is an option for some patients who require a left internal mammary artery bypass graft to the left anterior descending artery.
A small, 2 – 3 inch incision is made in the chest wall between the ribs, whereas the incision made during traditional CABG surgery is about 6 – 8 inches long and is made down the centre of the sternum (breastbone). Saphenous (leg) vein harvest may also be performed using small incisions.
Benefits of Minimally Invasive Surgery
The benefits of minimally invasive surgery include:
- A smaller incision
- A smaller scar
- Reduced risk of infection
- Less bleeding
- Less pain and trauma
- Decreased length of stay in hospital after the procedure (the average stay is about three days after minimally invasive surgery, while the average stay after traditional heart surgery is five days)
- Decreased recovery time (The average recovery time after minimally invasive surgery is 2 – 4 weeks; while the average recovery time after traditional surgery is 6 – 8 weeks)
For some surgical procedures, an endoscopic or ‘keyhole’ approach may be performed. This approach may also be referred to as port access surgery or video-assisted surgery. The port access surgery technique allows surgeons to use one to four small (5 – 10 mm) incisions or ‘ports’ in the chest wall between the ribs. An endoscope or thoracoscope (thin video instrument that has a small camera at the tip) and surgical instruments are placed through the incisions. The scope transmits a picture of the internal organs on a video monitor so the surgeon can get a closer view of the surgical area while performing the procedure.
Types of surgeries that may be performed using the innovative port-access or ‘keyhole’ approach include:
- CABG surgery
- Valve surgery
- Bi-ventricular pacemaker lead placement on the surface of the left ventricle
- Minimally invasive surgery for atrial fibrillation – Specialized instruments are used to create new pathways for the electrical impulses that trigger the heartbeat. Unlike traditional surgery for atrial fibrillation, there is no large chest wall incision, and the heart is not stopped during the procedure.
- Video-assisted thoracoscopy (VATS) is a minimally invasive surgical technique that may be used during some types of thoraicic surgeries, such as partial resection of the lung, lung biopsy, lobectomy, drainage of pleural effusions, or pericardial and mediastinal biopsies.
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