January 2015

Minimally Invasive Cardiac Surgery- The New Revolution

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The best aspect of this surgery is a slight cosmetic scar, early discharge, and mobility experience, says Dr SK Sinha, Director CTVS, Paras Healthcare

Dr SK Sinha

Dr SK Sinha,
Director CTVS,
Paras Healthcare

What is minimally invasive cardiac surgery (MICS)?

Minimally invasive heart surgery (also called keyhole surgery) is performed through small incisions (on sides of the chest), by using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 2 to 3 inches instead of the 6 to 8 inches incision required for traditional surgery. In this surgery the cardiothoracic and vascular surgeons (CTVS) operate on the heart between the ribs and hence do not split/divide the breast bone for heart access. This helps the surgeon by giving him a better view of the heart than open heart surgery and helps the patient as it reduces pain and guarantees quicker recovery. A heart-lung machine is also not needed for this surgery, and a device is attached to heart to stabilize it. The best aspect of this surgery is a slight cosmetic scar, early discharge, and mobility experience.

Is MICS the right choice for me?

Technology and advancements in science are to make our life easier. It is essential for us to embrace the developments. MICS is a novel safe and broadly applicable technique for performing a wide range of complex heart procedures, including single or multiple heart valve procedures, bypass surgery, congenital heart repairs, and reoperations. At Paras Hospitals, the CTVS department has a cumulative experience of performing more than 500 minimal invasive cardiac surgeries on patients from all over the world. If one has been advised cardiac surgery and wants faster discharge, easy mobility and less trauma, then one should definitely opt for the same. Then again, who wouldn’t want such an option that saves you from the perils of a traumatic conventional cardiac surgery?

But it should also be noted that not everyone is a candidate for these surgical techniques. The CTVS surgeon will review the results of your diagnostic tests before your scheduled procedure to determine if you are a candidate for minimally invasive surgery. The surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques versus traditional surgery techniques.

If it is so good, why is it not used more frequently or in all heart surgeries?

Minimal invasive cardiac surgery is performed aggressively in developed countries, however in India the trend is yet to be replicated. This delay is due to the gap in expertise, skill and precision. This revolutionizing procedure ensures that patients are treated with minimum scars, less pain and improved results. At Paras we ensure that by proper patient selection the best surgical results are achieved. Also this is a specialized procedure and not everyone is a candidate for the same.

What do you feel are the key patient benefits for a minimally invasive cardiac surgery?

The benefits of minimally invasive cardiac surgery techniques are many, few are mentioned below:

  • Smaller incisions
  • Small scars- in women the same can hide below the breast
  • Less pain and trauma
  • Shorter ICU and hospital stay after surgery: The average stay is 3 to 5 days after minimally invasive surgery, while the average stay after traditional heart surgery is 7 to 10 days
  • Low risk of infection
  • Low risk of bleeding and blood
    transfusion
  • Quicker return to normal activity
  • Shorter recovery time and faster return to normal activities/work: The average recovery time after minimally invasive surgery is 1 to 2 weeks while the average recovery time after traditional heart surgery is 6 to 8 weeks
  • Division of the breastbone is not needed

From the surgeon’s perspective, are minimally invasive procedures more difficult considering there isn’t direct, open access to the heart?

Definitely! What we are attempting to do is evolving a major cardiac surgery into something similar to a general day care laparoscopic surgery. Just imagine the impact of the same on the psych of the patient. At present the patients are traumatized by the very thought of their breast bone being cut.

Skill, precision and the use of specialized instruments is exceptionally essential. A surgeon needs to trust himself and his team of specialists.

At Paras we ensure that by proper patient selection the best surgical results are achieved

Has the percentage of minimally invasive procedures increased over the past few years? If so, why?

Yes, the numbers have increased, however the same is not exponential.

This is because one need skill, precision and training to perform the same. Moreover, specialized instruments are also required. Hospitals usually either lack trained manpower or do not have the resources for new instruments. The medical colleges also do not provide any specialized and recognized training for MICS. The same is purely dependent on the will, skill, and learning bent of mind of the doctors. Due to all these reasons the patient awareness for the same is also less. However, with the advent of training programs the popularity and demand of this specialized procedure is definite to rise.

Can you estimate what percent of your operations require some form of minimally invasive procedures?

We try and treat every patient that walks into our portals with MICS. However not every patient is suitable for the same. At present 50 percent of our cases are treated through MICS technique.

What minimally invasive cardiac surgeries does Paras Hospitals offer?

The minimally invasive heart surgery procedures performed at Paras Hospitals have demonstrated that it is a safe and broadly applicable technique for performing a wide range of complex heart procedures, including single or multiple heart valve procedures, bypass surgery, congenital heart repairs, and reoperations.

Most patients are candidates for minimally invasive heart surgery which has become the preferred approach at Paras Hospitals for the majority of our heart surgery patients, including:

  • Mitral valve repair and replacement
  • Aortic valve replacement
  • Atrial septal defects
  • Coronary artery bypass
  • Atrial myxoma removal

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