Advent Of Minimally Invasive Descending Thoracic Aortic Surgery
Juan A. Siordia, Jr., MD, Peter A. Knight.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: Despite advances into the minimally invasive era, descending thoracic aortic surgery remains a large and morbid procedure. Endovascular techniques are suitable for high-risk patients, but the reoperation risk is high and the survival benefit is lower than open surgery after 2 years with low-risk patients. Open protocols must adapt to minimally invasive techniques in to provide the durable benefit while optimizing outcomes.
METHODS: A minimally invasive descending thoracic aortic aneurysm repair is simulated with a porcine thorax model. Two 5 cm minithoracotomies were performed on the 2nd and 5th intercostal space. A port for a 10 mm 30 degree endoscope was placed for extra visualization. A simulated aortic graft is sewn into place with shafted instruments. Techniques seen in a typical open procedure were performed, including proximal anastomosis, intercostal artery ostia closure, intercostal island patch placement, and distal anastomosis.
RESULTS: The descending thoracic aortic repair was performed successfully through the minthoracotomies. The graft was sewn similar to an open procedure. Different suturing devices were used in order to perform the necessary suturing. Current suturing technology proved moderately difficult in order to complete the necessary procedures. Nevertheless, feasibility and the concept of a minimally invasive approach is demonstrated with a porcine thorax model.
CONCLUSIONS: Minimally invasive descending thoracic aortic surgery is highly possible. The current study demonstrates the feasibility of a descending thoracic aortic repair through two minithoracotomies with video guidance in a porcine thorax model. Further research is required to refine technology and techniques.
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