Over the past 100 years, the operative treatment of heart disease has seen many brilliant advances. Developments like the heart-lung machine and coronary artery bypass surgery (CABG) have not only revolutionized the field of cardiac surgery, but have also played a critical role in the development of modern day medicine. Today, a new innovation has captured the imagination of surgeons and patients alike. This innovation is an operation known as Minimally Invasive Heart Surgery, which achieves all the desired results, but with minimal harm to the patient. These operations are most commonly performed through smaller incisions sited in the least visible locations to make the scars most cosmetic, or without the use of harmful surgical equipment [1].
Brief History of Minimally Invasive Surgery
The minimally invasive ideal initially emerged around 25 years ago with the re-emergence of laparoscopy - a procedure that passes a telescope-like instrument with a built-in light source 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 [3]. Laparoscopy suddenly caught the imagination of general surgeons who saw great potential for 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 laparoscope (promptly re-named a "Thorascope") the pioneers examined diseases of the lungs and food pipe, and carried 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 [1].
CABG and Minimally Invasive Heart Surgery
Since it's inception 40 years ago, CABG has virtually been perfected. With a 99% success rate and years of proven reliability, CABG is the gold standard in cardiac bypass surgery. However, conventional CABG is still traumatic and gruesome operation. The surgeons of yesteryears are famous for the speed with which they finished operations and the number of operations they've performed (Denton Cooley, M.D. and founder of the Texas Heart Institute, and his associates have performed nearly 100,000), rather than finesse or artistry. Consequently, no one had considered the heart amenable to a minimally invasive approach. However, a better understanding of surgical physiology and a confidence with minimally invasive procedures led to the 1995 inception of minimally invasive heart surgery [3].
Today, a fury of progressive development into less invasive forms of heart surgery has resulted in several distinct forms of minimally invasive heart surgery, all of which aim to achieve the same beneficial effects of CABG without the pain and trauma associated with this major operation. This page aims to describe and compare three such procedures - Port Access surgery, Off-Pump Coronary Artery Bypass (OPCAB), and Minimally Invasive Coronary Artery Bypass (MIDCAB) - together with the future applications of robotics and laser surgery within minimally invasive heart surgery.
