Small right vertical infra-axillary incision for minimally invasive port-access cardiac surgery: a moving window method

Abstract

Port-access cardiac surgery has been developed to minimize skin incision and improve cosmetic outcomes. Using this method, a skin incision is generally made just above where the thoracotomy will be placed, horizontally along the intercostal space at the anterolateral submammary position. However, this type of incision can affect the frontal view and shape of the breast. Here, we report our experience with minimally invasive cardiac surgery using a port-access approach via a small vertical right infra-axillary incision and a moving window method. Twenty patients underwent surgical procedures with this approach from December 2010 to January 2012. Thirteen patients underwent mitral valvuloplasty, four mitral valve replacement, one mitral and tricuspid valve replacement and atrial septal defect closure and two atrial septal defect closure. All surgical procedures were completed using this minimally invasive method. All patients had an uneventful recovery and indicated that they were satisfied with the cosmetic results during the follow-up. Our experience suggests that this technique can effectively minimize skin incision and improve cosmetic outcomes.

Figure 1:

An incision line 5–6 cm in length is marked along an antero-axillary or midaxillary line (A). The layer under the pectoralis major muscle is dissected and the fourth intercostal space identified. The scheduled line moves ahead, and the window is retracted on the fourth intercostal space anterolaterally (B). The window is fixed to a suitable place with a retractor (C).

Figure 2:

(A) The skin incision on the midaxillary line is not visible from a frontal view. (B) The incision line is not visible if the arm is not pulled back from a lateral view.