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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the use of minimally invasive procedures for cardiac surgery.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEdward B. Savage, MD, Cleveland Clinic, Weston, Florida, USA, discussed the use of minimally invasive procedures for cardiac surgery. In his opinion, minimally invasive surgery is safe for coronary bypass and aortic and mitral valve surgery. Its use may result in faster recovery, especially in older patients. However, patient expectations for this type of surgery need to be carefully managed, and the risk and benefits should be better described.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EWhen considering surgery, patients generally want to minimize pain, cosmetic deformity, disability, and recovery time, and often, their perception of the magnitude of surgery is based on the location and size of the incision. Partially in response to these concerns, many cardiac surgeons are turning to minimally invasive techniques. Most surgeons acknowledge, however, that smaller or alternative incisions do not always equate to less pain or shorter hospitalizations, and they express that they have other considerations for using a less invasive strategy. These include the presumption of less physiological disruption, lower rates of infection, and fewer neurological complications. In some cases, however, these assumptions have yet to be proven. Other misperceptions concerning minimally invasive surgeries are that they result in overall cost savings due to faster recovery times, fewer blood products that are used, and fewer days spent in the hospital. While this may have some truth, the cost of newer equipment can sometimes offset these savings. For example, the increased cost to the hospital because of equipment can be as much as $1000 to $6000 per case, especially if robotics is involved.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENevertheless, surgeons are quickly adopting minimally invasive approaches. But, do these approaches reduce morbidity? Some nonrandomized and small randomized trials show improved early outcomes, including fewer transfusions and shorter length of stay, but others do not. No large randomized comparative trials have been performed. One study by Lamelas et al. [\u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2011] suggests that the use of minimally invasive surgery for isolated valve lesions reduces morbidity and mortality in patients aged \u0026gt;75 years compared with median sternotomy. In a study that was conducted by Dr. Savage [Szwerc MF et al. \u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 1999], no difference was found in early outcomes when upper sternotomy and full sternotomy for aortic valve surgery were compared. Nevertheless, Dr. Savage feels that there is a benefit of using a mini-incision if the operation can be safely performed through the incision. In most cases, isolated aortic valve replacement, as well as ascending aortic and arch replacement, can be performed through an upper sternotomy. Dr. Savage has also performed right coronary bypass and tricuspid and mitral valve surgery through this incision. The mini right thoracotomy approach has also been used for aortic, mitral, and tricuspid valve surgery. This approach is generally associated with less blood loss.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EMinimally invasive surgery using robotics is also increasing (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), primarily for mitral valve surgery with a similar approach to mini right thoracotomy. As with minimally invasive approaches, patients also have misperceptions about the use of robotics, some of which are due to how the use of robotics is presented by the surgeon. Patients are often led to believe that there will be no incision and that they will be back to work more quickly. The reality is that robotics will still involve cardiopulmonary bypass, and cardiopulmonary bypass times are longer. It is also important to consider experience with robotics, as there is a very steep learning curve for the entire team. No study has shown the use of robotics to be superior to mini right thoracotomy, and it is substantially more costly. However, as technology improves and costs are reduced, the robot may be more commonly used for certain types of heart surgery.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Minimally Invasive Robotic Surgery.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1022810927\u0022 data-figure-caption=\u0022Minimally Invasive Robotic Surgery.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/34\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/34\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/34\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12578\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMinimally Invasive Robotic Surgery.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from E. Savage, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/9\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmzxe\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmzxe\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}