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Review
. 2020 Oct 21;28(4):708-724.
doi: 10.5606/tgkdc.dergisi.2020.19614. eCollection 2020 Oct.

Minimal access in cardiac surgery

Burak Onan  1
Affiliations
Review

Minimal access in cardiac surgery

Burak Onan. Turk Gogus Kalp Damar Cerrahisi Derg. .

Abstract

Over the past two decades, minimally invasive cardiac surgery has been adopted with the use of endoscopic methods in 1990s and advanced robotic surgery since the early 2000s. In parallel with technological developments, surgical experience has increased and several cardiac operations are able to be performed using different mini-incisions. In this review, we discuss approaches to minimally invasive cardiac surgery, incisions, technical details, and suggestions.

Keywords: Minimally invasive cardiac surgery; surgical approach; surgical incision.

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Conflict of interest statement

Conflict of Interest: The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. Instruments for minimally invasive cardiac surgery.
Figure 2
Figure 2. Illustrations of upper (left view) and lower (right view) partial sternotomy.
Figure 3
Figure 3. J-sternotomy for aortic valve replacement. RA: Right anterior; LA: Left anterior.
Figure 4
Figure 4. Lower partial sternotomy incision. RAA: Right atrial appendage; SVC: Superior vena cava; IVC: Inferior vena cava.
Figure 5
Figure 5. Right anterior mini-thoracotomy incision. SVC: Superior vena cava; ICS: Invasive cardiac surgery; RA: Right anterior.
Figure 6
Figure 6. Right anterolateral mini-thoracotomy for port-access procedures without rib retraction.
Figure 7
Figure 7. Surgical set-up for port-access and robotic surgery. IJV: Internal jugular vein; TEE: Transesophageal echocardiography; ICS: Invasive cardiac surgery.
Figure 8
Figure 8. Basic tips and tricks for a better exposure during port-access mitral valve surgery. (a) Retraction suture to the right atrial appendage; (b) pericardial stay sutures; (c) Retraction of the left atrial incision; (d) Exposure for mitral valve repair.: RAA: Right atrial appendage.
Figure 9
Figure 9. Atraumatic vascular bulldog clamps for vena cava occlusion.: SVC: Superior vena cava; IVC: Inferior vena cava.
Figure 10
Figure 10. Position and skin landmarks for minimally invasive direct coronary bypass.: ICS: Invasive cardiac surgery.
None
Left anterior mini-thoracotomy for minimally invasive direct coronary bypass grafting
Figure 12
Figure 12. Robotic endoscopic harvesting of the LITA.: LITA: left internal thoracic artery; RFN: Right phrenic nerve; LSA: Left subclavian artery.
Figure 13
Figure 13. Robotic set-up for intracardiac procedures.
See this image and copyright information in PMC

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