Minimally Invasive Cardiac Surgery

New techniques in heart surgery have allowed many common open-heart operations to be performed through smaller and less traumatic incisions. Since 1994 Cedars-Sinai Medical Center has been performing operations on infants, children and adults using these techniques, making recovery much easier for the patient.

Cedars-Sinai Medical Center was the first to establish a minimally invasive heart surgery program for children west of the Mississippi and has extensive experience. Using techniques that make less of an impact on a young patient's body has often resulted in early discharge from the hospital and a speedy return to normal childhood activities. Limited incisions lower the risk of long-term complications in children without affecting treatment of the underlying heart disease.

Among the many innovations used at Cedars-Sinai for advanced minimally invasive surgery is the robotic surgical system. This system improves a surgeon's ability to perform complex minimally invasive surgery and makes possible microsurgical procedures that conventional surgical techniques cannot achieve.

The system consists of three or four robotic arms, one to position the endoscope and the remainder to hold surgical instruments. The surgeon can precisely control the surgical instruments with his hands while the positioning of the endoscope is voice controlled. A video display of the high-definition endoscopic image allows the surgeon to see inside the patient's body in far greater detail. This system improves the surgeon's precision and ability to manipulate instruments in small spaces, helping to make the procedures even less invasive.

Valve replacement and heart artery bypass can be performed through small incisions and do not require cutting through the breastbone (sternum). These operations involve lower risk and do not affect the treatment of the underlying heart disease.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that uses small incisions and eliminates the need to spread the ribs. VATS is performed through a one-inch incision and is aided by a miniature camera inserted through one of the three quarter- to half-inch incisions. The VATS approach is certainly not painless, but it does hurt less than a large thoracotomy. The average hospitalization after the operation is four days, and patients usually do not require a stay in the intensive care unit.