Minimal Access Cardiac Surgery

If the surgical advances of the last decade were to be characterized in a single phrase, it would be the ineluctable movement toward minimal access surgery.

Beginning in 1910 with Jacobaeus' work with pleural space problems and tuberculosis and progressing with the development of fiberoptic light sources and imaging successively through gynecologic surgery with tubal ligation, general surgery with cholecystectomy, and orthopedic surgery with arthroscopy, this movement has reached full flower as new technologies are brought to bear on cardiothoracic surgery. The technology associated with this movement is moving so quickly that one might question whether a full-blown text in this area would be yesterday's news by the time it became available.

Minimal access surgeries are procedures performed through small incisions. It is an advancement to traditional surgical techniques, where large incisions are required for the surgeon to have a clear view of the operating site. Cardiac surgeries are traditionally performed through an open method, where a long incision is made down the chest, and the breast bone is separated to expose the heart. Now, the same is made possible with the use of a fiber-optic tube called a laparoscope, which has a light source and a camera attached to its end. When passed into the body through a small incision, the camera captures and displays the operating site for the surgeon to view on a TV monitor.

Procedure

Minimal access to cardiac surgery is performed under general anesthesia. Depending on the operation, 3 to 4 incisions of approximately 3 to 5 cm may be made on your chest. The laparoscope is inserted through one of the incisions, and other surgical instruments are inserted through the other incisions. The laparoscope guides your surgeon visually through the surgery by projecting the internal images onto a monitor. You are connected to a heart and lung machine which performs the normal function of the heart during the operation.

Once the operation is completed, drains are placed, the incision is stitched together, and you are taken to the intensive care unit. The drains are removed after a day or two of the surgery

Minimal access to cardiac surgery advantages may include:

  • Less pain
  • Shorter hospital stay
  • Smaller scars
  • Less blood loss
  • Faster recovery