What is minimally invasive cardiac surgery (MICS)?
Minimally invasive cardiac surgery (MICS) is a modern technique of heart surgery that is done by using small incisions, instead of a large opening in the chest, as done in traditional open-heart surgeries. Surgeons use various special instruments and cameras to gain access to the heart through small cuts that are made between the ribs. Minimally invasive cardiac surgery (MICS) reduces the trauma to surrounding muscles and bones, which leads to reduced pain, less loss of blood, and a faster recovery for patients.
Types of Minimally Invasive Cardiac Surgery (MICS)
There are several types of minimally invasive cardiac surgery (MICS) methods, depending on the heart condition it is used to treat, namely
- Thoracoscopic surgery is a method in which a surgeon makes a small incision in the chest wall to allow a long tube with a high-definition camera (thoracoscope) for viewing. Long and thin tools are used for surgery. The other name for Thoracoscopic surgery is keyhole surgery.
- Robotic-assisted surgery is a method in which the surgeon controls robotic arms with the help of a computer console. This system of robots provides a 3D view of the heart and translates the exact movement of the surgeon’s hands into accurate actions with the help of various tools.
- Minimally invasive direct coronary artery bypass (MIDCAB) is a technique used for coronary artery bypass grafting, but it avoids a full division of the breastbone, that is, sternotomy.
- Transcatheter procedure, these may not be completely surgical types of minimally invasive cardiac surgery (MICS), but are the least invasive, where a catheter is inserted through a small hole made in the groin region or chest. Examples of this include Transcatheter Aortic Valve Replacement (TAVR) and MitraClip for mitral valve repair.
- Partial sternotomy is used for some valve surgeries; a small incision is made, and the upper breastbone is split, instead of the full division.
Minimally invasive cardiac surgery (MICS) is used to treat several heart issues. Some of the common procedures treated are Coronary artery disease, Valvular heart diseases, Arrhythmias, Congenital heart diseases, Cardiac tumors, and End-stage heart failures.
| Procedure Name | Minimally Invasive Cardiac Surgery (MICS) |
|---|---|
| Type of Surgery | Major surgery |
| Type of Anesthesia | General anesthesia |
| Procedure Duration | 3-6 hours |
| Recovery Duration | 3-5 days full recovery, 2-3 weeks |
Minimally Invasive Cardiac Surgery (MICS): Pre-Op & Post-Op Care
The procedure for minimally invasive cardiac surgery (MICS) is divided into three different phases: pre-operative phase, intra-operative phase, and post-operative phase. These phases are designed to make sure of patient safety, accuracy of procedure, and optimal recovery. The pre-operative stage is examining the patient and making them ready for surgery, which is followed by the surgical procedure itself during the intraoperative stage, and finally the post-operative stage, where the patient returns to normal activities after surgery becomes an essential objective.
Pre-operative Care: Before the start of the MICS procedure
The objective of minimally invasive cardiac surgery (MICS) is careful examination of the patient to ensure that the patient is fit to undergo the procedure and to identify if there are any underlying risks.
Standard evaluations include examination of the medical history of the patient, physical evaluation, and standard lab tests that may involve blood tests and an electrocardiogram.
Use of imaging techniques like computed tomography (CT) angiography to examine the chest anatomy and the condition of the arteries that may be used for cardiopulmonary bypass (CPB) during the procedure, for example, the femoral arteries.
Transesophageal echocardiography is used to examine the heart’s function and its anatomy.
A team of experienced cardiologists and anesthesiologists then evaluates the patient for any situations in which the patient cannot undergo minimally invasive cardiac surgery (MICS).
The patients then receive instructions for discontinuation of some medicines, especially blood thinners like aspirin and clopidogrel, before the start of minimally invasive cardiac surgery (MICS) to reduce the risk of bleeding.
Intra-operative care:
The intraoperative phase of minimally invasive cardiac surgery (MICS) includes several challenges, one of which is operating through small incisions.
The first step involves giving general anesthesia to the patient, where the airway is managed with the help of an endotracheal tube, to allow single lung ventilation, especially when thoracotomy is used.
The patient is positioned in a tilted way to optimize the exposure to surgery, and care is taken to provide support for pressure points to avoid any nerve injury.
Cannulation is used in case of cardiopulmonary bypass (CPB), the heart-lung machine is connected, and cannulas are placed in peripheral vessels, such as the femoral artery and vein.
Specialized tools are used, especially long-handle instruments that include thoracosopes and robotic arms to operate in the chest cavity.
The surgeon then makes one or more small incisions that are typically 2-4 inches long in between the ribs via a partial or upper sternotomy.
If the heart needs to be stopped during the procedure, then cardioplegia is delivered, and then the aorta is clamped.
The surgeon then performs the procedure of either repairing or replacing a valve or performing a bypass graft.
After the procedure is complete, the surgical team performs a complex task to remove all the air from the heart chambers. Drainage tubes are placed, and then incisions are carefully closed.
Post-operative: After the minimally invasive cardiac surgery
Recovery from a minimally invasive cardiac surgery (MICS) procedure is faster than open heart surgery, but still involves closer monitoring and rehab.
The patient is moved to the recovery room, and his vitals are then monitored.
Intravenous lines, a urinary catheter, and chest drainage tubes are used.
The patients are often placed on fast-track protocols, allowing for earlier extubation from the ventilator, sometimes directly in the operating room.
Many patients are moved from the intensive care unit within 24 hours and have a hospital stay of 3-5 days.
The patient is advised to start minimal walking a day or two after the surgery to avoid any complications.
Pain management is done through pain medications, but pain in the minimally invasive cardiac surgery (MICS) procedure is less compared to the open heart surgery technique.
Gradual activity increase instructions, heart-healthy diet, cardiac rehab techniques, and timely follow-up advice are then given by the surgical team.
Benefits of Minimally Invasive Cardiac Surgery (MICS) at Yashoda Hospitals
- Quicker recovery
- Less blood loss
- Shorter hospital stays
- Cost-effective
- Lower infection risk
- Enhanced patient satisfaction
- Minimal tissue injury
- Equivalent outcomes to any traditional surgery.
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