Minimally Invasive Surgery
Minimally invasive techniques—which drastically
reduce complications, pain, scarring and recovery time associated with
surgery—are available to treat a range of conditions, including valve
disease, coronary artery disease (“off-pump procedures”), arrhythmias,
atrial fibrillation, heart failure, thoracic aneurysms and repair
atrial septal defects.
Minimally
Invasive Heart Valve Surgery
Minimally invasive heart valve
surgery is a technique that uses smaller incisions to repair or
replace heart valves. This means there is less pain. Minimally
invasive surgery also reduces the length of the hospital stay and
recovery time. Instead of a traditional sternotomy incision (through
the breast bone) a smaller thoracotomy (right chest) incision is made.
This speeds recovery time and minimizes post-operative activity
limitations.
Minimally invasive valve surgery
can only be done in certain patients. This type of surgery cannot be
done in patients
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With severe valve damage
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Who need more than one valve repaired or replaced
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Who have clogged arteries (atherosclerosis)
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Who are obese
In some cases, minimally invasive valve surgery can be done using a
robot. Robotic surgery does not require a large incision in the chest.
Our surgeons are well trained in this technique.
Minimally Invasive CABG "Off-Pump"
Off-pump bypass surgery is considered minimally invasive. The
heart-lung machine is not used. Rather than stopping the heart,
technological advances and new kinds of operating equipment now allow
the surgeon to hold portions of the heart stable during surgery. With
a particular area of the heart stabilized, the surgeon can bypass the
blocked artery in a highly controlled operative environment.
Meanwhile, the rest of the heart keeps pumping and circulating blood
to the body.
Off-pump coronary artery bypass surgery may be performed in certain
patients with coronary artery disease. With our present technology,
all arteries on the heart can be bypassed off-pump. It may be ideal
for certain patients who are at increased risk for complications from
cardiopulmonary bypass, such as those who have heavy aortic
calcification, carotid artery stenosis, prior stroke, or compromised
pulmonary or renal function. Not all patients are candidates. The
selection of which patients undergo off-pump surgery is made at the
time of operation when the patient’s heart and arteries are evaluated
more closely.
Endoscopic Vein Harvest
Drs. Lewis and Beggs routinely
perform endoscopic vein harvesting on almost all coronary artery
bypass patients. Various studies indicate that Endoscopic Vein
Harvest is the preferred method of harvesting veins for coronary
bypass surgery. With conventional vein removal, a long incision is
made in the selected leg from the ankle to the mid-thigh. With
endoscopic vein removal, a small incision (one inch or less) is
made just above the knee. The vein is then removed using a small
flexible scope. The rate of infection with Endoscopic Vein Harvesting
is drastically reduced and there is much less swelling (edema) of the
leg. It does not add to the length of the surgery or to the length of
the hospital stay. There is also a dramatic reduction in pain. In
addition, the incision behind the knee is barely noticeable, and the
cosmetic effect is well received by patients.
ASD Repair
A relatively common congenital
heart defect, an atrial septal defect refers to a hole in the wall
separating the top two chambers of the heart. This hole allows already
oxygenated blood to flow back to the lungs, reducing the heart's
efficiency and eventually leading to pulmonary hypertension and other
complications. Surgical repair is typically recommended.
The repair has traditionally been
performed through a sternal incision. However, through the development
of minimally invasive techniques this rather simple operation can be
completed via a 4 cm incision in the right chest wall. Soon the
surgery will be performed routinely under robotic assistance with
pinhole incisions. Ask your surgeon at the time of your consultation
if you are a candidate for this procedure.
Video Assisted Thoracoscopy
A VATs (video assisted thoracoscopy)
is a procedure that involves the use of a thin, fiberoptic scope with
a camera attached. Instruments can then be inserted into the chest
through small incisions made between the ribs. This allows your
surgeon to take biopsies, confirm a diagnosis, and perform wedge
resections (remove a section of the lung). A chest tube will be placed
at the time of the procedure to drain any fluids from surgery and help
re-expand the lung. This will be removed when the drainage has stopped
and there are no further air leaks, usually in a few days. The site
will be tender for several weeks afterward and you will be discharged
with pain medications. You will have no activity restrictions with the
exception that you must not drive when using pain medications.
