Minimally Invasive Thoracic Surgery - Benefits and Risks

Introduction:

Surgeries are a complicated procedures often done as a part of the treatment. In some cases, surgeries might be done for cosmetic results. The surgeries might be done with cutting open the skin or thye might be done in a minimal invasive way. The thoracic surgeries done without cuting open the skin and done through minimal invasive ways.

What Is Minimally Invasive Surgery?

Minimally invasive thoracic surgery is a chest surgery performed by making a small incision instead of a large cut or incision in the body. Also, this surgery is performed without spreading the ribs apart to gain access to the internal organs. Instead, the doctors use a camera and instruments through the small incision between the ribs to reach the lungs. The two options available to do this surgery are:

• Video-assisted thoracoscopic surgery (VATS).

• Robotic-assisted surgery.

What Is Video-Assisted Thoracic Surgery?

Video-assisted thoracic surgery (VATS) is a procedure done with the help of a small tube called a thoracoscope inserted via a small cut or incision between the ribs. A camera at the end of this tube will let the surgeon see the inside of the chest cavity through a screen without the need to cut open the chest or spread the ribs. Then the surgeon removes the lung tissue through another one or two incisions made using specially designed instruments for the same.

The patient's general health, the lesion's location, and the procedure's complexity are important things to be considered. If the lesion is near any vital structure, following standard thoracotomy is suggested rather than doing VATS. Also, the patient must be able to handle single collateral lung ventilation and have enough oxygenation and systemic blood pressure. Patients with severely impaired lungs are not good candidates for VATS. Also, if the patient has undergone thoracic surgical procedures like thoracotomy or pleurodesis (a procedure done to obliterate the pleural space to avoid pleural infections) are considered contraindications for undergoing VATS. Proper consent, like conversion to standard thoracotomy in case of a compilation or difficulty completing the procedure via VATS, is needed. This procedure is done by a trained and well-experienced surgeon capable of managing emergency thoracic compilation.

What Is Robotic Assisted Surgery?

During robotic-assisted surgery, the surgeon will sit in a console near the patient in the operating room and control the instruments like a camera in the robotic system. Through one of the small incisions, a 3D camera is placed, which will provide a view inside the chest cavity. Next, the robotic instruments are inserted through another small incision in the chest. The lung tissue is removed through one of the incisions made. With the help of a wristed instrument, the surgeon can do the surgery without making a big opening in the chest.

What Are the Benefits?

The benefits are mentioned below:

• Faster recovery and return to normal activities.

• Lesser complications.

• Shorter duration of hospital stay than thoracotomy.

• Comparatively less pain and need for pain medications.

• Smaller scars.

• Less blood loss.

• No cutting of the ribs or breastbone.

The surgery will depend on the surgeon and several factors, like the patient's overall health, the type of condition, and the surgeon's experience.

Why Is It Done?

Many types of heart surgeries are done using minimally naive surgery, and they are:

• Coronary artery bypass surgery.

• Aortic valve replacement.

• Atrial septal defect and patent foramen ovale closure.

• Saphenous vein harvest for coronary artery bypass surgery.

• Atrioventricular septal defect surgery.

• Maze procedure for atrial fibrillation.

• Mitral valve repair or replacement.

• Tricuspid valve repair or replacement.

What Are the Risks?

Minimally invasive heart surgery can have risks that are there with open thoracic surgery, and they are:

• Bleeding.

• Infection.

• Stroke.

• Irregular heart rhythms (arrhythmias).

• Death.

Changing the minimally invasive surgery to open thoracic surgery is possible if the surgeon thinks continuing with the surgery will be unsafe with the minimal approach.

What to Expect during the Surgery?

Minimally invasive surgeries consist of robotic assistant surgeries, thoracoscopic surgery, and surgery done through a small incision in the chest. In all these surgeries, the surgeon accesses the heart or the lungs through small cuts rather than opening the thorax and exposing them between the ribs. A bronchoscope will help to view the inside of the chest cavity in case of surgery through a small incision made. Most minimally invasive surgery uses a heart-lung bypass machine which will let the blood move through the entire body even during the surgery.

• Robot-Assisted Heart Surgery- In this type of surgery, the surgeon uses a robotic hand rather than their hand to do the same things as done in any traditional open heart surgery. While doing this type of surgery, the surgeon will work in a remote console and see the heart in a 3-D magnified high definition on a monitor. From that console, the movement of the surgeon's hand will be transferred to the robotic hands at the operating table. Another surgeon, a team of doctors, and other staff will do this at the operating table, like changing the instruments attached to the robotic arms.

• Thoracoscopic Surgery- In this type of surgery, a thin tube is attached to a camera, called the thoracoscope, also known as mini-thoracotomy, and is inserted into the chest cavity by the surgeon. The surgery is performed by inserting the instruments through the incisions between the ribs.

What Is the Result?

The symptoms of aortic stenosis may be reduced by minimally invasive heart surgery, and it can improve the quality of life. The patient should do regular checks with the doctor to continuously monitor the condition of the heart, and certain tests might be done to check the condition of the heart. The doctor will suggest lifestyle changes to improve heart health, like eating a healthy diet, regular exercise, managing stress, and avoiding using cardio-toxic substances. Sometimes a customized, personalized education and exercise program may be suggested to improve the health following surgery.

Conclusion:

Minimally invasive heart surgeries are performed through small incisions rather than open heart surgery. They are less invasive, and post-operative healing happens faster than an open chest surgery. The surgeon might suggest this surgery to repair the heart valves, remove tumors, or correct any heart defects. In addition, they have comparatively less recovery after the surgery, and the scars are smaller than in open chest surgery.