Minimally Invasive Heart Surgery - an Introduction
Dateline: 12/21/97
In last week's article, we discussed one of the birth defects of the heart, TGA. For more on birth defects, visit the Congenital Heart Disease Online site.
This week, I begin a series of articles on the hottest topic in heart surgery this year - Minimally Invasive Heart Surgery. Over the next few weeks, we will trace here the origins and rapid growth of this technique, and try and to separate the hype from the truth.
Introduction
The study of the evolution of operative treatment of heart disease is fascinating. So many improvements have been made in the last 100 years of its practice that cardiac surgeons would today be hard pressed to master every advance. And yet, THE single development that has captured the imagination of patient and doctor alike in recent years is the concept of MINIMALLY INVASIVE SURGERY.
Traditionally, surgery has been a traumatic and gruesome profession. The surgeons of yesteryears were famous for the speed with which they finished operations, rather than finesse or artistry. However, with better understanding of surgical physiology, the modern practice of surgery has veered towards achieving the same beneficial effects without the pain and trauma of major operations.
What is Minimally Invasive Surgery ?
The term means essentially what it says - operations that cause minimal injury to the patient, yet achieve all they are meant to. Most commonly, what it means is that operations are performed through smaller incisions sited in the least visible locations to make the scars most cosmetic.
A brief history of Minimally Invasive Surgery
The trend towards minimal invasiveness started around two decades back, with the re-emergence of laparoscopy on the surgical scene. Laparoscopy is the use of an instrument resembling a telescope with its in-built light source, that is passed into the abdomen through tiny incisions in the belly. Through this telescope, the surgeon is able to directly view organs inside the abdomen, and even perform operations on them. Laparoscopy, which was in common use even in the late 1800's, primarily in gynecologic surgery, suddenly caught the imagination of today's general surgeons who saw great potential in its use in other situations. Laparoscopic Cholecystectomy (removal of a diseased gall bladder using a laparoscope) was the most popular of these applications, and suddenly everyone was talking about MINIMALLY INVASIVE SURGERY.
Thoracic surgeons (who operate upon the lungs and other organs inside the chest) were quick to see the potential in their field as well. Using a modified laparascope - which they prompty re-named a THORACOSCOPE - the pioneers started examining diseases of the lungs and food pipe, and even carrying out minor operations. As they gained experience and confidence, and as technological developments helped create better and versatile instruments, more and more complex operations became possible.
Minimally Invasive HEART Surgery
Until now, no one had considered the heart amenable to this minimally invasive approach. But it was now time for the Cardiac Surgeon to get his act together - and he did it in style !
Dr.Valavanur Subramanian - he's special to me, since he shares my name and my hometown of Madras, India - was one of the first proponents of Minimally Invasive heart surgery. With an exciting combination of innovativeness, tremendous skill and courage, he first performed a coronary artery bypass operation through a tiny incision in the chest wall, without using the heart-lung machine to assist the circulation. He coined the term MIDCAB - Minimal Invasive Direct Coronary Artery Bypass - for this revolutionary technique that created a flutter in the cardiac surgical community.
Ever since then, modifications and improvements in this field have happened with startling rapidity. Today there are many minimal invasive procedures for coronary artery bypass grafting, heart valve repair and replacement, and even congenital heart disease.
Over the course of the next few weeks, I will focus on different aspects of this new trend in heart surgery. Next week we will discuss Minimally Invasive Coronary Surgery, so keep coming back !
Let me know:
How did you like this week's article ? Please write to me and let me know.
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Suggested Reading on Heart Disease:
For more information on Congenital Heart Disease, visit the Heart Disease Online site.
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