Uchida Tetsuro, Hamasaki Azumi, Kuroda Yoshinori, Mizumoto Masahiro, Yamashita Atsushi, Hayashi Jun, Gomi Seigo, Sadahiro Mitsuaki, Abiko Akihiro, Kondo Shunichi
Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Kyobu Geka. 2015 Jan;68(1):4-10.
Minimally invasive cardiac surgery (MICS) through a small intercostal thoracotomy has many advantages, but it is still challenging because of limited mobility through the small skin incision and surgical field. The benefits of MICS should be reached without compromising the quality of the operation and increasing the morbidity and mortality of standard sternotomy approach. We have recently introduced MICS-aortic valve replacement (AVR) in order to establish as a standard surgical technique for the treatment of aortic insufficiency.
Eleven consecutive patients underwent MICS-AVR in Yamagata University Hospital. Anesthetic and surgical techniques were simplified and standardized as possible to overcome technical difficulties. Preoperative chest computed tomography( CT) provides useful information about suitability of the patient's anatomy for MICS approach. Furthermore, we developed a preoperative image overlay technique by projecting 3-dimensional CT image over the patient's body surface.
There was no operative death. MICS-AVR procedure was completed in 10 patients. One patient was converted to sternotomy approach probably because of the vascular spasm through femoral artery cannulation for extracorporeal circulation. Although there were some anxious points to manage MICS procedure, preoperative planning based on the image overlay from CT image were useful for setup and instrument placement for MICS.
MICS-AVR was introduced and safely performed with acceptable morbidity and excellent mortality at our institution. Close observation should be mandatory in order to implement individual and departmental performance monitoring with regard to the learning curves and surgical complications associated with less invasive procedure itself.
通过小切口肋间胸廓切开术进行的微创心脏手术（MICS）有许多优点，但由于小皮肤切口和手术视野导致的活动受限，其操作仍具有挑战性。在不影响手术质量且不增加标准胸骨切开术方法的发病率和死亡率的情况下，应实现MICS的益处。我们最近引入了MICS-主动脉瓣置换术（AVR），以确立其作为治疗主动脉瓣关闭不全的标准手术技术。
山形大学医院连续11例患者接受了MICS-AVR手术。麻醉和手术技术尽可能简化和标准化，以克服技术困难。术前胸部计算机断层扫描（CT）可提供有关患者解剖结构是否适合MICS方法的有用信息。此外,我们通过将三维CT图像投影到患者体表上，开发了一种术前图像叠加技术。
无手术死亡。10例患者完成了MICS-AVR手术。1例患者可能因体外循环股动脉插管时血管痉挛而转为胸骨切开术。虽然在处理MICS手术时有一些令人担忧的问题，但基于CT图像叠加的术前规划对于MICS的设置和器械放置很有用。
我们机构引入了MICS-AVR并安全实施，发病率可接受，死亡率良好。为了对与微创操作本身相关的学习曲线和手术并发症进行个人和部门绩效监测，应进行密切观察。
