How to set-up a program of minimally-invasive surgery for congenital heart defects

Tóm tắt Đặt vấn đề: Phẫu thuật tim ít xâm lấn phát triển mạnh trên thế giới và đã được chứng minh đem lại nhiều lợi ích cho người bệnh. Chúng tôi thực hiện nghiên cứu này nhằm đánh giá tính khả thi và an toàn của kĩ thuật phẫu thuật ít xâm lấn điều trị các dị tật tim bẩm sinh. Phương pháp nghiên cứu: Đây là nghiên cứu mô tả hàng loạt ca được thực hiện tại khoa Phẫu thuật tim mạch Bệnh viện Đại học Y Dược thành phố Hồ Chí Minh. Tất cả các người bệnh có dị tật tim bẩm sinh được phẫu thuật ít xâm lấn sửa chữa dị tật từ tháng 7/2014 đến 7/2018 được thu thập số liệu. Kết quả: Tổng cộng có 134 trường hợp: mở ngực phải có nội soi hỗ trợ (nhóm 1): 62 ca (46%), mở ngực nhỏ giữa xương ức (nhóm 2): 72 ca (54%). Nhóm 1: tuổi trung bình 27.6 ± 14,7 tuổi (6 – 63 tuổi), tỷ lệ nam : nữ là 1:2,1, cân nặng trung bình 47,0 ± 9,9 kg (16 – 60kg). Nhóm 2 : tuổi trung bình 6,5 ± 4,3 tuổi (1 – 24 tuổi), tỷ lệ nam: nữ là 1,4:1, cân nặng trung bình 12 kg (7,5 – 54 kg). Các dị tật bẩm sinh được phẫu thuật: thông liên nhĩ, thông liên thất, kênh nhĩ thất bán phần, tim ba buồn nhĩ, bất thường hồi lưu tĩnh mạch phổi. Các kỹ thuật phẫu thuật được thực hiện: vá thông liên nhĩ, vá thông liên thất, sửa van 2 lá, sửa van 3 lá, sửa chữa bất thường hồi lưu tĩnh mạch phổi. Trong 2 nhóm, người bệnh được rút nội khí quản sớm (3-6 giờ sau mổ), thời gian nằm hồi sức tim trung bình 2 ngày, thời gian nằm viện sau mổ trung bình là 5 ngày và không có trường hợp tử vong. Kết luận: Phẫu thuật ít xâm lấn sửa chữa dị tật bẩm sinh khả thi và an toàn. Đường mổ ít xâm lấn ngực phải có sự hỗ trợ của nội soi cũng như đường mở ngực giữa nửa xương ức giúp tiếp cận tốt các tổn thương bẩm sinh: thông liên nhĩ, thông liên thất, tổn thương van nhĩ thất … để thực hiện các thao tác sửa chữa. Abstract Introduction: The concept of minimally invasive surgery for congenital heart disease in pediatric surgery is accepted worldwide with the aim to reduce trauma during operation. Since 2014, we have adopted a minimally surgical approach to manage the congenital heart defects. We conduct the study to identify the effectiveness and the safety of this approach. Material and Methods: Between July 2014 and July 2018, all patients who underwent a minimally invasive surgical approach at the University Medical center HCMC, were enrolled. The database including the outcomes, patients clinical conditions and satisfaction at follow-up were collected and analyzed. Results: There were 134 patients with congenital heart defects underwent minimally invasive repair. Group 1 (right video-assisted minithoracotomy): 62 patients (46%), group 2 (midline ministernotomy): 72 patients (54%). Group 1: mean age 27.6 ± 14.7ys (6 – 63 ys), male/ female ratio was : 1:2.1. Group 2: mean age 6.5 ± 4.3ys (1 – 24 ys), male/ female ration was : 1.4:1. The congenital heart defects are ASD, VSD, AVSD, Cor-triatristum, PAPVR, etc. Procedure performed are ASD closure, VSD closure, pulmonary veins rerouting, AV valve repair, etc. In both groups, all patients were removed the endotracheal tube within 3-6 hours, and discharged within 5-7 days. There was no mortality in this series. Conclusion: Approach and repair the congenital heart defects via right video- assisted thoracotomy and minimally midline sternotomy are safe and effective. Keyword: Minimally invasive approach; Congenital heart defects.

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Minimally invasive partial inferior sternotomy for congenital heart defects in children

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2006-925603 ◽

2006 ◽

Vol 54 (S 1) ◽

Author(s):

R Seipelt ◽

T Tirilomis ◽

T Paul ◽

H Dörge ◽

F Schoendube ◽

...

Keyword(s):

Minimally Invasive ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects

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Effects of minimally invasive and traditional surgeries on the quality of life of children with congenital heart disease: a retrospective propensity score-matched study

BMC Pediatrics ◽

10.1186/s12887-021-02978-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hui Tan ◽

Erjia Huang ◽

Xicheng Deng ◽

Dongping Li ◽

Shayuan Ouyang

Keyword(s):

Quality Of Life ◽

Congenital Heart Disease ◽

Heart Disease ◽

Minimally Invasive Surgery ◽

Propensity Score ◽

Minimally Invasive ◽

Invasive Surgery ◽

Congenital Heart ◽

Physical Appearance

Abstract Background The focus of clinical care after treating congenital heart disease (CHD) has shifted from saving patients’ lives to improving their quality of life. This study aimed to examine the influence of minimally invasive and traditional surgeries on the quality of life of children with CHD. Methods This was a retrospective cross-sectional study. A total of 459 children aged 2–18 years with CHD treated at Second Xiangya Hospital of Central South University from July 2016 to June 2017 were enrolled, among whom 219 underwent minimally invasive surgery and 240 traditional surgery. The quality of life of children with CHD after surgery was reported by the patients’ parents. We applied propensity score matching to correct for confounding factors and conducted multiple linear regression analysis to examine the related effects of minimally invasive and traditional surgeries on the quality of life of children with CHD. Results The scores of problems related to perceived physical appearance in children undergoing minimally invasive surgery was higher than those in those undergoing traditional surgery (p = 0.004). Different treatment modes were independent influencing factors for problems related to perceived physical appearance in children with CHD. There was no significant difference in average treatment effect scores of children undergoing different surgical procedures in other quality of life dimensions (problems related to cardiac symptoms and their treatment, drug treatment, anxiety regarding treatment, cognitive psychology, and communication), suggesting that different operation modes were not independent influencing factors for these related problems. Conclusion Compared with traditional surgery, minimally invasive surgery can significantly improve the physical appearance perception scores of children with CHD after surgery. Therefore, minimally invasive surgery can improve the quality of life of children with CHD.

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Robotic Laparoscopic Single-Site Surgery

10.5772/intechopen.96226 ◽

2021 ◽

Author(s):

Rene I. Luna

Keyword(s):

Minimally Invasive Surgery ◽

Robotic Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Minimally Invasive Surgical Procedures ◽

Single Site ◽

Proper Understanding ◽

Minimally Invasive Surgical ◽

Set Up ◽

Single Site Surgery

Minimally invasive surgery has changed the landscape of women’s surgical healthcare. Conventional and robotic laparoscopy are the preferred approach for many major minimally invasive gynecological procedures. However, the philosophy of minimally invasive surgery has been pushed to reduce the size and minimize the number of ports placed. Many conventional minimally invasive surgical procedures use 3–5 ports through multiple small incisions. Laparoscopic single site surgery tries to perform on that philosophy but has its limitations. Enters robotic surgery already a major force in minimally invasive surgery and now sets to remove the limitations of single site surgery. However it requires proper understanding of the instruments and the techniques for successful robotic single site surgery. It starts with patient selection. Knowing the instruments needed and the proper set up of those instruments. Then knowing how to use the instruments in operating and suturing and closing. And finish with special considerations.

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Performance Increase in Venous Drainage for Mini-Invasive Heart Surgery: Superiority of Self-Expanding Cannulas

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000083 ◽

2014 ◽

Vol 9 (4) ◽

pp. 297-301 ◽

Cited By ~ 4

Author(s):

Mhedi Belkoniene ◽

Saad Abdel-Sayed ◽

Julien Favre ◽

Ludwig-Karl Von Segesser

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Centrifugal Pump ◽

Invasive Surgery ◽

Heart Surgery ◽

Small Diameter ◽

Venous Drainage ◽

Superior Performance ◽

Set Up ◽

Q Values

Objective Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. Methods To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Results Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, −5.4, −15.9, −45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Conclusions Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

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