Cardiac surgery using a single thoracic port-current status and future directions (original) (raw)
Related papers
Transverse sternotomy for concomitant cardiac and pulmonary surgery
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1984
We describe a simplified surgical procedure whereby pulmonary or other intrathoracic operations can be safely and easily performed in conjunction with cardiopulmonary bypass for indicated cardiac procedures. Transsternal bilateral anterior thoracotomy can provide excellent exposure in cases requiring concomitant attention to cardiac and pulmonary pathology.
Single-port video-assisted thoracic surgery (VATS)—advanced procedures & update
The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.
Full-Spectrum Cardiac Surgery Through a Minimal Incision: Mini-Sternotomy (Lower Half) Technique
The Annals of Thoracic Surgery, 1998
A technique is described in which most, if not all, cardiac operations may be performed through a standard small incision. A midline, lower half sternotomy is used. This provides traditional exposure of the heart and allows the surgeon to directly visualize the operating field and use familiar instruments. The complete spectrum of coronary revascularization and cardiac valve operations has been performed through this less-invasive incision.
From full thoracotomy to uniportal video-assisted thoracic surgery: lessons learned
Journal of Visualized Surgery, 2017
Over the last two decades, conventional video-assisted thoracic surgery (VATS) has established itself as the preferred approach for almost all thoracic surgical procedures. The procedure provides a safe and easy approach with undisputed patient benefit at a cost acceptable to the healthcare system all over the world, in large hospitals as well as underprivileged rural areas. VATS has effectively addressed the patients' right to less scarring, trauma (both of access and intrathoracic manipulation), medication, pain, hospitalization, and early return home and work. These improvements have been further stressed by the introduction of uniportal VATS (uniVATS). Single port surgery is a very exciting new modality in the field of minimal access surgery which aims at further reducing scars of standard vats and towards an hypothetical prospective of scarless surgery.
World Journal of Surgery, 1999
To minimize surgical trauma, the use of Port Access cardiac surgery was initiated in patients (pts) with coronary artery disease (CAD) (42 pts) or mitral valve disease (MVD) (24 pts) in March 1996 at our institution. Altogether 42 pts (36 men, 6 women; age 31-75 years, median 59.0 years) with isolated lesions of the left anterior descending (LAD) artery underwent Port Access coronary artery surgery (PACAS). A small (5-9 cm) incision was done parasternally on top on the fourth rib. The left internal mammary artery (LIMA) was dissected through the minithoracotomy or by using an additional thoracoscopic approach. A total of 24 pts (12 men, 12 women; age 30-75 years, median 62 years) underwent Port Access mitral valve surgery (PAMVS). In these pts the procedure was performed through a small right thoracotomy (6-8 cm). In all cases, endovascular cardiopulmonary bypass (CPB) was instituted through femoral cannulation, and an additional endoaortic balloon catheter was introduced into the ascending aorta for aortic occlusion. In pts with PACAS the survival was 98% (41/42) and in the PAMVS group 100%. All pts but one survived the PACAS and are well today. There were no deaths in the PAMVS group. The hospital stay was reduced by 1 day on average after PACAS and 3 days after PAMVS. Thus in well selected patients Port Access cardiac surgery represents a safe and feasible minimally invasive surgical approach that avoids the potential complications of a sternotomy while offering the advantages and safety of CPB and cardioplegic arrest. This minimally invasive approach offers a shortened hospital stay and earlier rehabilitation.
Mitral surgery after prior cardiac operation:port-access versus sternotomy or thoracotomy
The Annals of Thoracic Surgery, 2002
In reoperation for mitral valve disease, minimally invasive Port-Access (PORT) is a new alternative to standard median sternotomy (STER) or right thoracotomy (THOR); yet, the results of PORT in this setting have not been defined. The aim of this study was to evaluate the results of minimally invasive thoracotomy in reoperation for mitral valve disease. Retrospective results are reported for three consecutive series of patients undergoing reoperation for mitral disease using either PORT (n = 60, 1996 to 2001), THOR (n = 37, 1985 to 1997), or STER (n = 155, 1985 to 1997). Red cell transfusion was 3 +/- 4, 14 +/- 13, and 12 +/- 12 units for PORT, THOR, and STER, respectively. Chest tube output was 352 +/- 361, 2048 +/- 3166, and 1683 +/- 3939 mL, respectively. Cardiopulmonary bypass times for these groups were 208 +/- 76 vs. 158 +/- 56 vs. 157 +/- 53 minutes. Thirty-day mortality was 0/60 (0%), 8/37 (22%), and 21/155 (14%), respectively. This early clinical experience suggests that PORT is an acceptable alternative to THOR or STERN in reoperation for mitral valve disease, with potential advantages of avoiding redo sternotomy and reducing the surgical incision. However, these benefits may come at the expense of longer cardiopulmonary bypass times.
Port Access? surgery for congenital heart disease*1
European Journal of Cardio-Thoracic Surgery, 1999
Objectives: Minimally invasive surgical techniques have been introduced into cardiac surgery in order to avoid median sternotomy related complications. Surgical trauma to the patient can be signi®cantly reduced without compromising the safety. In addition, a small lateral chest incision results in improved cosmesis, especially in female patients. Methods: Thirteen patients (median age 39^14 years, ranged from 17± 61 years) with atrial septal defect were treated with a minimally invasive surgical method using a modi®ed Port Accesse technique. In all patients access to the heart was achieved via a small (4±8 cm) right lateral chest incision in the 4th intercostal space. In these patients the selection of the Port Accesse system was used for cardiopulmonary bypass via the femoral vessel and for the application of cardioplegic solution. Results: No deaths or intraoperative complications were observed in any of the patients. The postoperative course was uneventful and only minor complications were observed postoperatively. The median hospital stay was 8:0^1 days (median^SEM). Conclusion: This minimally invasive surgical technique for the treatment of atrial septal defects represent a safe alternative to conventional treatment of ASD using median sternotomy and standard cardiopulmonary bypass. The exposure of the right atrium via the 4th intercostal space is ideal and can be performed with excellent cosmetic results. q
Multivessel Revascularization on the Beating Heart by Anterolateral Left Thoracotomy
Annals of Thoracic Surgery, 2006
Background. Off-pump coronary artery bypass is commonly performed through a full median sternotomy; however, the tendency to reduce surgical trauma has stimulated cardiac surgeons to use less invasive techniques for single-vessel disease. The use of thoracotomy for reoperative and valvular surgery has also been reported, but its application in primary revascularization is still uncommon. We report here a series of consecutive patients who underwent complete myocardial revascularization on the beating heart through anterolateral thoracotomy-coronary artery bypass (ALT-CAB).
Minimally Invasive Cardiac Surgery by the Port-Access Method
Artificial Organs, 2002
Recently, minimally invasive surgery has come to be an important theory in cardiac surgery, the goal of which is shortening of hospital stay, earlier recovery of employment, and cosmetics. In this paper, we will describe our experience with port-access cardiac surgery conducted under the support of our new technology. This study assesses the quality of cardiac surgery performed by the port-access method. The author developed a direct endoaortic clamp balloon (Yozu balloon). This balloon is a triple-lumen balloon catheter of 3.6 mm in outer diameter and 40 cm in full length. The balloon is inserted directly into the ascending aorta. Injection of cardioplegic solution and aortic vent can be conducted. Also, we introduce a modified Cosgrove flex clamp to apply in small-incision surgery, aiming at a less invasive procedure. The modified point is that the original, united Cosgrove flex clamp can be divided into the handle part equipped with a ratchet, and the bellows part equipped with a clamp jaw. By this modification, it became possible to apply the Cosgrove flex clamp transthoracically; that is, it became possible to conduct aortic clamping safely and securely through this small port of 8 mm in diameter. Port-access cardiac surgery is one of the developing and promising methods of cardiac operation. In view of future technological progress, we can expect the gradual but wide popularization of this method.