Conventional Cardiac Surgery have been performed world wide very successfully over past 50 Years.Introduction of Minimally Invasive (M.I.)techniques in Surgical specialities brought Paradigm shift in decision making in Cardiac Surgery also.The Basic Principle of Minimally Invasive surgery is to avoid the Complications of ACCESS trauma(Surgical Entry wound).If Access Trauma can be reduced without compromising the efficacy of the procedure,Less Invasive operation will be successful.
MICS is not a single procedure, but refer to all procedures where full sternotomy is avoided. Various approachs used in MICS are-
MICS was introduced in1995 on this principle by Benetti et al in Brazil .Firstly,MICS was done for Coronary Artery Bypass Surgery(CABG) and it was extend to Mitral valve(heart valve) surgery. This development was possible due to
Routine Cardiac surgery is done by sternum (chest bone) split which involves about 12-15 cms incision.In MICS , approach is by 7-8 cms Chest incision on side.To work in little more depth,Special Chest wall retractor & Long Double Jointed Instruments are developed.Tissue Stablization or Retraction are achived by Endoscopic tissue stabilizer or Suction stabilization(Octopus).Optical visualization is achived by Telescopic camera .Improvement in perfusion technology have enable us to use Alternate Route of Femoral Vessels(groin area) for Cardiopulmonary bypass.
Advantages of MICS
Anesthesia Protocols for MICS
Guidewires & venous cannula placement
MICS basically includes five types of Cardiac surgery procedures
Major contributory cause of problems in coronary surgery are due to
Extension of MIDCAB for Multi Vessel Grafting with different conduits(Radial or Saphenous) are being developed but long term results are awaited.
Problems of Access Trauma was also the main factor for evolution of this technique.Mitral valve surgery is commonly done with Small Right Thoracotomy (via 4th ICS)&Aortic valve surgery was done via Mini sternotomy Or RT Thoracotomy(3rd ICS) .Cardiopulmonary Bypass was achived by femoral vessels route & operation is performed with the help Long shaft instruments,Endoscopic visualization & Self Retaining Retractor system.Long term results are good & comparable to conventional surgery.
ASD Closure is also done by Rt.Thoracotomy(4th ICS).This procedure can be done comfortably by this approach.Cardio-pulmonary Bypass is achived by Central Cannulation(aortic & atiral) or peripheral cannulation(femoral vessels).Long term results are comparable with conventional surgery.
Endoscopic Vein Harvesting(EVH)
Saphaneous vein harvesting for CABG can be done in minimally invasive way with the use of special instrument set known as VASOVIEW (MAQUET).Long incision of leg can be avoided. This procedure requires two small incisions & have a steep learning curve. It consists of subcutaneous dissection of vein (Tunnelling) &division of the branches using electrocautery. So wound healing is faster with less complications.
Problem of adequacy of body perfusion in case of small femoral artery is always present. Higher rate of Stroke(6.4%vs. 2.4%)in Retrograde perfusion in patients above 45 year is also a point for consideration.
In earliar experience,Balloon clamp(endo clamp) was used .This had reported many aortic injuries. So transthoracic clamp have been used routine for cross clamping.
Use of single two stage or double venous cannula is also a debatable aspect.
Minimally Invasive Cardiac Surgery gaining popularity gradually.Long term outcome of MIVS are very good and comparable to routine procedure.Single vessel MIDCAB is very satisfactory.Early complication rates in term of Bleeding, Pain, Recovery & Hospital stay are much less with MICS.
Copyright by Dr Sanjay Kumar Agarwal 2019. All rights reserved.
Copyright by BoldThemes 2018. All rights reserved.