Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. These procedures involve use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimally invasive heart and lung surgery may result in shorter hospital stays, or allow for outpatient treatment.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
MIDCAB is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG. MIDCAB is sometimes referred to as “keyhole” heart surgery because the operation is analogous to operating through a keyhole.
MIDCAB is a form of off-pump coronary artery bypass surgery (OPCAB), performed “off-pump” (without the use of cardiopulmonary bypass machine). MIDCAB differs from OPCAB in the type of incision used for the surgery; with traditional CABG and OPCAB a median sternotomy (dividing the breastbone) provides access to the heart; with MIDCAB, the surgeon enters the chest cavity through a mini-thoracotomy (a two to three inch incision between the ribs).
Off-Pump Coronary Artery Bypass (OPCAB)
A coronary artery bypass graft (CABG) done without putting the patient on the heart-lung machine. Off-pump CABG permits surgery on multiple vessels within the heart by mechanically stabilizing it. Off-pump surgery is minimally invasive, as compared to surgery on the heart-lung machine. The potential benefits include shorter hospital stay, less bleeding, less chance for infection, less risk of irregular heartbeats (arrhythmia), less trauma, shorter recovery time, and greater cost effectiveness.
Minimally Invasive Valve Repair and Replacement
Minimally invasive mitral valve repair surgery is performed through a small incision, often using specialized surgical instruments. The incision is two to four inches instead of the siz to eight inch incision required for traditional surgery. Robotically assisted keyhole approaches or port-access techniques are also available for some types of surgery. The benefits of minimally invasive mitral valve surgery may include: reduced pain, reduced blood loss, reduced risk of infection, shorter hospital stay, faster recovery, faster return to work, less scarring and improved post-surgery appearance.
Robotically-assisted mitral valve surgery is a type of minimally invasive surgery in which the surgeon uses a specially-designed computer console to control surgical instruments on thin robotic arms. The robotic arms are introduced through a one inch incision in the right side of the chest. The surgeon’s hands control the movement and placement of the endoscopic instruments to open the pericardium (thin sac that surrounds the heart) and to perform the procedure. Robotically-assisted mitral valve surgery provides the surgeon with an undistorted, three-dimensional view of the mitral valve, leaflets and subvalvular structures with the use of special camera. This approach enables surgeons to perform complex repairs without the need for division of the breast bone (sternum) or spreading of the ribs, in most cases.
Transmyocardial Laser Revascularization (TMR / TMLR)
TMR is a new treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A specialized laser is used to create small channels in the heart muscle, improving blood flow in the heart. TMR is a surgical procedure. The procedure is performed through a small left chest incision or through a midline incision. Frequently, it is performed with coronary artery bypass surgery, but occasionally it is performed independently.
Download our TMR information packet here.
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Endoscopic Vein Harvesting (EVH)
During coronary artery bypass graft surgery, a surgeon takes a segment of a healthy blood vessel (an artery or vein) from another part of the body and uses it to create a detour or bypass around the blocked portion of the coronary artery. That process is called vein harvesting. Traditionally, vein harvesting is accomplished through a lengthy surgical incision in the leg. However, a less invasive method called endoscopic vein harvesting (EVH) is becoming more common and is the preferred method of vein harvesting among centers that are properly equipped.
Traditional vein harvesting requires an incision to remove the blood vessel being used for the bypass graft, leaving the patient with a long scar. By contrast, EVH requires one to three small incisions, each less than 1 inch in length. A special video camera (called an endoscope) is then used to allow the physician to clearly view the vein harvesting.
In addition to avoiding scar tissue, patients undergoing EVH are also less likely to experience complications and usually have shorter recovery times. Because of these advantages, more bypass procedures are being performed using endoscopic vein harvesting. Most people who require a bypass operation are candidates for EVH.