Minimally invasive paediatric cardiac surgery.

The concept of minimally invasive surgery for congenital heart disease in paediatric patients is broad, and has the aim of reducing the trauma of the operation at each stage of management. Firstly, in the operating room using minimally invasive incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, image-guided intracardiac surgery, and minimally invasive cardiopulmonary bypass strategies. Secondly, in the intensive-care unit with neuroprotection and 'fast-tracking' strategies that involve early extubation, early hospital discharge, and less exposure to transfused blood products. Thirdly, during postoperative mid-term and long-term follow-up by providing the children and their families with adequate support after hospital discharge. Improvement of these strategies relies on the development of new devices, real-time multimodality imaging, aids to instrument navigation, miniaturized and specialized instrumentation, robotic technology, and computer-assisted modelling of flow dynamics and tissue mechanics. In addition, dedicated multidisciplinary co-ordinated teams involving congenital cardiac surgeons, perfusionists, intensivists, anaesthesiologists, cardiologists, nurses, psychologists, and counsellors are needed before, during, and after surgery to go beyond apparent technological and medical limitations with the goal to 'treat more while hurting less'.