Minimally Invasive Surgery
OverviewMinimally Invasive Cardiac Surgery
New techniques in heart surgery have allowed many common open-heart operations to be performed through smaller and less traumatic incisions. Since 1994 Cedars-Sinai Medical Center has been performing operations on infants, children and adults using these techniques, making recovery much easier for the patient.
Cedars-Sinai Medical Center was the first to establish a minimally invasive heart surgery program for children west of the Mississippi and has extensive experience. Using techniques that make less of an impact on a young patient's body has often resulted in early discharge from the hospital and a speedy return to normal childhood activities. Limited incisions lower the risk of long-term complications in children without affecting treatment of the underlying heart disease.
Among the many innovations used at Cedars-Sinai for advanced minimally invasive surgery is the robotic surgical system. This system improves a surgeon's ability to perform complex minimally invasive surgery and makes possible microsurgical procedures that conventional surgical techniques cannot achieve.
The system consists of three or four robotic arms, one to position the endoscope and the remainder to hold surgical instruments. The surgeon can precisely control the surgical instruments with his hands while the positioning of the endoscope is voice controlled. A video display of the high-definition endoscopic image allows the surgeon to see inside the patient's body in far greater detail. This system improves the surgeon's precision and ability to manipulate instruments in small spaces, helping to make the procedures even less invasive.
Valve replacement and heart artery bypass can be performed through small incisions and do not require cutting through the breastbone (sternum). These operations involve lower risk and do not affect the treatment of the underlying heart disease.
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that uses small incisions and eliminates the need to spread the ribs.
It is used to treat patients who were born with a problem involving the heart or nearby blood vessels. Known as congenital heart disease, the condition affects approximately eight children in every 1,000 births. Defects can show up at birth, as the child grows or even in adulthood.
VATS is performed through a one-inch incision. The surgeon is aided by a miniature camera inserted through one of three quarter- to half-inch incisions. While VATS is not painless, it hurts less than a large thoracotomy.
The benefit of using VATS is that, in many cases, surgery takes less than an hour and the patient can leave the hospital 24 hours after surgery. Also the technique can be used on patients weighing as little as two pounds.
Minimally Invasive Direct Coronary Artery Bypass
This is a new type of surgery that uses smaller incisions to do the bypass. As a result, there is sometimes less pain and a faster recovery compared to more traditional open chest heart surgery. This procedure may be done without stopping the heart. It can be done to bypass one or more coronary blood vessels.
Some patients can leave the hospital within 48 hours. This operation is only used for patients whose blockages can be bypassed through the smaller incision and whose risk of complications is low. You should find out from your surgeon if this is an option for you.
Another approach used to minimize the impact of surgery during a coronary bypass operation is what is called beating heart surgery. This can be used both with minimally invasive surgery or traditional open chest surgery. During this type of surgery, the heart is beating and the heart-lung machine is not used.
Many factors determine whether traditional, beating heart or minimally invasive coronary artery bypass surgery is best. Discuss these options with your surgeon.
Minimally Invasive Valve Surgery
Minimally invasive heart valve surgery uses smaller incisions to repair or replace heart valves. This means there is less pain, a shorter stay in the hospital and a faster recovery.
Minimally invasive valve surgery can only be done in certain patients. This type of surgery cannot be done in patients who:
- Have severe valve damage
- Need more than one valve repaired or replaced
- Have clogged arteries (atherosclerosis)
- Are obese
- Have had previous heart surgeries
Robotic Heart Surgery
Robotic surgery is now a reality at Cedars-Sinai Medical Center for some heart patients. A robotic device can be used to assist the surgeons in doing some of the minimally invasive surgeries, such as valve repair and replacements and simple bypass surgeries.
The evolution of increasingly successfully and increasingly lower risk procedures will continue as new techniques are developed. The future holds many promises for the treatment of heart disease. Our surgeons and cardiologists will stay at the forefront of those treatments.