When you think of heart surgery, what comes to mind is a major operation that involves cutting the chest down the middle and opening it up, right? Many people are actually afraid of it. But did you know that with the advancement of medical science, heart surgery can now be performed without such a large incision, through one or more very small incisions? That is what we call "Minimally Invasive Heart Surgery". Some people also call this "keyhole surgery" because it is done like looking through a keyhole. So today, let's talk about this.
Simply put, what is this small-incision heart surgery?
This means that the large bone in the middle of your chest, the sternum , is not completely cut, as in traditional open-heart surgery. Instead, the surgeon makes one or more very small incisions on the side of your chest, between the ribs.
Then, through these small incisions, high-tech cameras, specially designed long, thin surgical instruments, or robotic arms are passed into the heart. The doctor uses a monitor to view the clear, magnified images from the camera and perform the surgery with great precision. This method results in less scarring, less pain, and a much shorter recovery time than the old method.
What are the main methods of performing these surgeries?
There are two main methods. Let's see what they are.
| Surgical method | How it happens |
|---|---|
| Thoracoscopic surgery | The doctor makes several small incisions in the side of the chest. Through one of them, a long tube with a video camera (thoracoscope) is inserted to obtain images of the heart. Through the other incisions, long, thin instruments are used to perform the operation. |
| Robotically assisted heart surgery | Here, too, small incisions are made in the chest. But the equipment is controlled by a robotic arm system that the doctor controls himself. This provides a very clear three-dimensional (3D) view of the heart. It can also perform the surgery more delicately and accurately than a human hand. |
What types of heart diseases is this method used for?
Although not all heart surgeries can be performed using this method, it can be used in many cases. For example:
- Atrial Septal Defect (ASD) closure
- Valve repairs or replacements. This method is especially popular for mitral valve repair.
- Treatment of irregular heartbeat (Maze procedure for atrial fibrillation)
- Cardiac tumor removal
- Some bypass surgeries (Coronary artery bypass surgery)
- Ventricular assist device placement
Your cardiologist and surgeon will best decide whether this method is appropriate for your condition.
What happens before and during the surgery?
Your doctor will give you all the necessary instructions before the surgery. You may be asked to stop taking certain medications (e.g., blood thinners) a few days before the surgery.
You will not feel anything during the surgery because you will be under general anesthesia. You will be connected to a heart-lung machine to maintain blood circulation in your body during the surgery.
The surgeon makes small incisions in the side of the chest, inserts instruments through them, and reaches the heart through the ribs to perform the necessary repair, valve replacement, or other treatment. This surgery can usually take two to six hours . When the work is complete, the incisions are stitched shut.
What are the benefits and risks of this surgery?
As we said before, there are many advantages to this method.
Advantages
- Fast recovery: You can usually return to normal activities within two to four weeks.
- Reduced pain: There is much less pain because there is no large incision or bone cutting.
- Reduced bleeding: There is less bleeding because the incisions are smaller.
- Reduced risk of infection: Since the wounds are smaller, the risk of infection is also reduced.
- Scars become smaller: Instead of a large scar all over the chest, only a few small, barely visible scars remain.
- Reduced hospital stay: You can usually go home in a few days.
Risks
As with any surgery, there are some risks, but these risks are minimal compared to open-heart surgery.
- Bleeding
- Infection
- Irregular heartbeats (Arrhythmias)
- Stroke- like conditions
Sometimes, very rarely, during surgery, if the doctor realizes that this small incision method is no longer safe, they may have to switch to a traditional open surgery method on the spot. Although this is not something that usually happens, it is important to be aware of it.
What happens after surgery? How to recover quickly?
After the surgery, you will be kept in the intensive care unit (ICU) for a day or two. Drainage tubes may be placed to drain any fluid that may have accumulated in your chest. After that, you will be transferred to a general ward and will stay in the hospital for a few more days.
You will be able to walk in a day or two. You will also be instructed to do breathing exercises to help clear the mucus from your lungs. You will need to avoid heavy lifting for a few weeks. Your doctor will tell you exactly when you can go back to work, drive, and exercise.
Doctors often refer you to a cardiac rehabilitation program , which helps you safely gradually increase physical activity and introduce you to a heart-healthy diet.
What are the symptoms that require you to see a doctor immediately?
If you experience any of the following symptoms after your surgery, call your doctor or seek treatment immediately .
- A pus-like fluid oozes from cuts.
- Excessive swelling or redness around the wound.
- Fever or chills.
- Feeling like your heart is beating fast (heart palpitations) .
- Abnormal swelling of the legs or feet (edema) .
- Weight gain of more than 1.5 kg (3 pounds) within a week.
Take-Home Message
- Minimally invasive heart surgery is a modern method of heart surgery that is performed through small incisions, without making a continuous cut in the chest.
- This method reduces pain, bleeding, scarring, and the risk of infection. It also shortens the recovery time.
- This method can be used for many conditions, such as heart valve repair and hole closure.
- Although this is a very successful procedure, like any surgery, there are some risks.
- Talk to your doctor about which surgical procedure is best for your condition and make the best decision.
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