Minimally invasive heart surgery is performed using keyhole surgery techniques, where instruments are inserted into the body through small incisions, rather than opening up the chest and cutting through the breastbone as in conventional types of heart surgery. One of the special instruments used is a type of telescope, which can be used to send back pictures so the surgeon can view the operation on a monitor. In some cases, minimally invasive heart surgery techniques do not involve the use of a heart-lung machine to keep the patient alive, because the operation is performed on a beating heart. This differs from traditional heart surgery where the heart is stopped. Robots are now used to help surgeons perform some minimally invasive heart surgery procedures.
Two techniques which can be used to bypass diseased and clogged-up coronary arteries, and restore an adequate bloodflow to the heart, are port-access coronary artery bypass, which is also known as PortCAB or sometimes PACAB, and minimally invasive coronary artery bypass, or MIDCAB. Both are examples of what is referred to as minimally invasive coronary artery surgery. In both of these procedures, the operation is carried out through small incisions in the chest. Metal tubes known as ports are inserted through the incisions, and specially designed surgical instruments can be passed along these tubes to the heart. A thin telescope attached to a camera is used to video the operation in real time, providing the surgeon with a view that would otherwise be missing due to the small incisions made.
Where PortCAB is the chosen method of minimally invasive heart surgery, the heart is normally stopped and the use of a heart-lung machine is required. Pieces of vein from the legs or sections of artery from the chest are used to create grafts which can divert blood around diseased coronary arteries. In MIDCAB, the heart-lung machine is not needed because the heart continues to beat, and this technique tends to be used where there are only a couple of coronary arteries to be bypassed. Chest arteries are used to supply the material for the grafts.
Compared with conventional coronary artery bypass graft surgery, which can also be referred to as CABG, the minimally invasive heart surgery techniques currently in use have the advantages that they use smaller incisions, which are quicker to heal and cause less scarring, and there is a decreased risk of infections. Also, less blood is lost, pain is minimized, and patients recover more quickly and can leave hospital earlier. The survival rates after surgery seem to be similar to those of people who have had conventional heart operations, although more research is needed before the full picture can be assessed. As the use of robotic assistance grows, this could help to improve precision.