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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimal Invasive Cardiac Surgery (mics) With Routine Instruments And Indigenous Techniques
Frankleena D. Parage, Sr., Varun Sisodia, Sr., Aparesh Sanyal, Sr., Sandeep Singh, Shamsher Singh Lohchab.
Pt.B.D.Sharma PGIMS University of Health Sciences Rohtak-India, Rohtak, India.

AbstractIntroduction: Minimal invasive cardiac surgery is popular due to it's various advantages like - minimal blood loss, reduced trauma, less postoperative pain, decreased duration of mechanical ventilation, cosmetically better scar, short hospital stay, quicker return to normal activities etc. MICS can be performed via mini thoracotomy, upper/lower sternotomy, video assisted, total endoscopic and robotic surgery. However, MICS can be performed in selected patients only and it may be difficult, challenging and back breaking for the surgeon to perform it. Methods: MICS was started in our institution in year 2010 and with a usual learning curve, is being performed in our institution without specialised instruments and with indigenous modification of techniques. Our preferred approach has been direct vision thoracotomy, initially slightly larger incision to small 6cm incision moving more laterally and inclusion of soft tissue retractor. Other technical modification were (i) adoption of modified Seldinger technique for femoral arterial and venous cannulation from initial direct femoral cut and central venous cannulation (ii) stay sutures on ascending aorta and RAA for antegrade cardioplegic cannulation (iii) Oblique curved long cross clamp directly through thoracotomy avoiding SVC compression with straight clamp (iv) easy manoeuvring of tape around IVC etc.Results: From 2011 to 2019 MICS was performed in patients as depicted in table Conclusion: MICS can be performed safely via direct vision mini thoracotomy approach with the routine instruments and indigenous techniques.
RESULTS
Sr no.Operative procedureNumber of patientsApproachMorbidityMortality
1.Mitral valve surgery67Right 4th intercoastal space mini thoracotomy1 (1.5%)2 (3%)
2.Mitral valve surgery with concomitant Tricuspid valve repair22Right 4th intercoastal space mini thoracotomy2 (9%)Nil
3.Mitral valve surgery with concomitant cryomaze11Right 4th intercoastal space mini thoracotomy1 (9%)Nil
4.Aortic valve replacement214-upper hemi sternotomy 17- right 2nd intercoastal space minithoracotomy1(5%) patient re-explored in view of secondary hemorrhageNil


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