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Last Post:
Nov 10, 2009 6:45 PM
by: Jeffrey Gibson
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9/23/08
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What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Mar 28, 2003 4:13 PM
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[nobr]What really constitutes minimally invasive cardiac surgery? Vassilios and I have set out the challenge in our editorial. Now I ask industry partners, staff surgeons, and residents to help us solve this conundrum. Through this ?Thread of Ideas? you have the opportunity to render your valuable opinion.
Frankly, I believe that MIS really is a philosophy comprised of many new technologic advances, techniques, and protocols. Our industry partners may say ? no it is using one of their devices to expose the heart for coronary surgery to avoid the pump and another may say the pump is OK as long as the incision is small. My robotic mitral valve operations are done through a small incision ? but -wow the pump times are longer. It this really minimally invasive? I believe that any cardiac surgical method designed to cause less ?assault? upon natural tissues and physiology deserves the imprimatur of ?Minimally Invasive?? Am I over simplifying the matter?
Ranny Chitwood
http://www.ctsnet.org/doc/7525 [/nobr]
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Posted:
Mar 29, 2003 12:59 PM
in response to: W. Randolph Chi...
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Is minimally invasive what Dr. Tatooles has set forth in his early discharge robotic mitral repairs. Please listen to his presentation on this page under - Meeting Presentations. Tony has presented some interesting and provocative ideas at the recent STS meeting.
WRC
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Posted:
May 1, 2003 10:12 AM
in response to: W. Randolph Chi...
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My definition of MICS has been, since 1996, a "strategy designed to deliver the desired form of cardiovascular therapy with the least change in homeostasis". The strategy is not limited to the surgeon but involves the team (anesthesia, perfusion). In this definition the opportunity of minimization of homeostatic changes involve not only size of incision, use of CPB, but also anesthetic techniques.
Makes sense to you?
Marco Zenati
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Posted:
May 2, 2003 5:09 PM
in response to: W. Randolph Chi...
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Dr Zenati has set forth a definition of minimally invasive surgery. How do others define it? I ahve asked some of our industry partners for their opinions. Stay tuned for their comments within the next several weeks.
It is still an enigma to me that I have seen patients benefit greatly from less invasive approaches with fewer transfusions and yet ...... many surgeons are reluctant to even try some of these methods. Pioneers like Dr. Cosgrove and Cohn as well as Mohr and Vannermen have already shown safety and eficacy. Patients want minimally invasive methods and I am finding them asking first about the trauma of surgery.
Your throughts R Chitwood
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9/23/08
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Posted:
Jun 2, 2003 6:50 PM
in response to: W. Randolph Chi...
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<< Is minimally invasive what Dr. Tatooles has set forth in his early discharge robotic mitral repairs. Please listen to his presentation on this page under - Meeting Presentations. Tony has presented some interesting and provocative ideas at the recent STS meeting.
WRC >>
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Posted:
Jun 16, 2003 12:00 PM
in response to: W. Randolph Chi...
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Minimally invasive clearly means many different things to different people. Some people are obsessed by small incisions, to achieve surgical success then they may need much longer bypas times. Others are obsessed by off-pump surgery, in return they may need much larger incisions to achieve adequate re-vascularisation. Do we really understand the trade-offs? Is an on-pump strategy with a very low blood product useage actually worse than an off-pump strategy in a unit that doesn't cell save and therefore has a higher transfusion rate. (yes it is true, you can be on-pump and still have a very low blood product useage. You do have to CARE about your transfusion levels though!) I have been struck looking at photographs of lower hemi-sternotomy that you can achieve, with care, a full sternotomy through the same skin incision. It is difficult but you can do it. Do we all wear headlights? I find it very difficult to use a small incision without a headlight, the corollary could be no head light therefore big incision, could it not?
We have to remember that we do live in a competitive world, cardiologists and patients are pushing us down routes that we consider might not be in the best interests of the patient. Outcome, survival and long term quality of life must be our drivers. Where we do things well we must market. If we truly believe in what we do then we must take up the challenges to demonstrate that what we do, be it, on or off pump, maximally or minimally invasive is of the highest currently attainable quality, but that we continue to strive to improve. If there are problems that we have not yet solved then we must solve them. At the end of the day we will have to transform our skills to meet the challenges as they arise, always realising that we must keep improving as cardiac suregry develops.
Russell Millner
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Re: What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Feb 25, 2007 2:30 PM
in response to: W. Randolph Chi...
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I agree that miniimally invasive surgery is a way of achieving surgical outcomes in a less traumatic approach. It is indeed a philosophy, and not just dependant upon the size of the incision.
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Re: What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Jun 24, 2008 12:34 PM
in response to: W. Randolph Chi...
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I won't tell you what it is, but I will tell you what it is NOT.
Minimally Invasive Cardiac Surgery is NOT taking an otherwise healthy 42 year old fit man with isolated LAD disease and doing a 9 hour robotic LIMA to LAD, when they could have had a median sternotomy and a 1 hour skin to skin operation.
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Re: What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Jul 29, 2008 1:00 PM
in response to: W. Randolph Chi...
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i think minimally invasive cardiac surgery is in trying to do the best operation with the least incision with the least change in homeostasis and least assault on the tissues leading to less pain, no transfusion, and faster recovry with the best long term results and no compromise on the final product to accomodate smaller incisions.
i do the whole spectrum of cardiac surgery through lower mini sternotomy and find the recovery much faster than witha full sternotomy.
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3/26/09
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Re: What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Mar 26, 2009 4:26 AM
in response to: W. Randolph Chi...
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I think MICS definition is all in the name itself. Its minimal invasion of everything.... the incision should be small; less invasive to the body; less traumatic to tissues; minimal changes in surgical physiology and last but not the least the minimum stress to the surgeon, anesthetist and the perfusionist ;-)
At present not all cardiac surgery can be done with MI, but I think we are going through a period of transition similar to which GI surgery passed through decades back, it was confined to lapchole, but now they do a lot of things; As an young surgeon, MICS catches my fancy and I love to train myself into it, as I know technology will develop and standardize MICS in the near future.
We require standardization of the whole philosophy of MICS. Heart port for instance can manage valve surgeries pretty well, but what about the time factor; I think the learning curve is not so long as people used to say before. Speed can be developed rapidly (no pun intended). MICS CABG is entirely different. Endovascular valve replacement is another field where lot of work is going on. So its all in the mind, we got to develop a wide vision for the narrow approach to minimally invasive surgery!!
Saluitations to Dr Chitwood for bringing out this topic. At present I am working with Dr Vanermen and I am totally impressed by his technique. Its for the pioneers like them to keep egging young surgeons like us to join the elusive club of MICS;
Thank you once again for posting this discussion.
Rajnish
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Re: What is Minimally Invasive Cardiac Surgery Anyway?
Posted:
Nov 10, 2009 6:45 PM
in response to: Rajnish Duara
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I, like Dr. Chitwood, am interested in achieving the least trauma when operating on my patients. However, my PRIMARY concern is a term we do not discuss often -- DURABILITY. If this goal can be achieved with smaller incisions, in a reasonable amount of time, good. For cardiac disease, we should aim first for DURABILITY.
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