Dodge-Khatami Jannika, Dodge-Khatami Ali, Nguyen Thai Duy, Rüffer André
Pediatric Cardiology, Department of Pediatrics, Faculty of Health, Helios University Medical Center Wuppertal, Witten/Herdecke University, Witten, Germany.
Clinic for Pediatric & Congenital Heart Surgery 2, Children's Heart Center, University Hospital RWTH Aachen, Aachen, Germany.
Transl Pediatr. 2023 Sep 18;12(9):1744-1752. doi: 10.21037/tp-23-282. Epub 2023 Sep 14.
Minimal invasive approaches through small thoracic incisions for the isolated repair of the most common congenital heart defects have been around for decades. However, the lack of belonging in established surgical training curriculums compared to the traditional median sternotomy, the requirement for more technical expertise and a certain learning curve, has limited their use, being routinely performed only by certain surgeons in specialized centers. More recently, through cumulated and increasingly mediatized shared experience, remote teaching potential through universally accessible surgical videos and simulation, the approach has gained traction and acceptance, and even established itself as the new norm in many centers. In this review, we present technically focused aspects of our own experience and protocols which have evolved over time, along with a brief overview of the literature pertaining to other right thoracic approaches, and some comparison to established results using the traditional median sternotomy. An increasing body of literature, produced more frequently and across all continents, seems to suggest that repairs of congenital heart defects through a minimal invasive right thoracic approach are becoming the new norm, as they are reported to be safe and reproducible, with excellent surgical results, and an obvious superior and more desirable cosmetic result. This comes at a cost of additional training and learning curve by surgeons, who are not offered the technique as part of their standard professional training curriculum.
通过小切口开胸的微创方法来单独修复最常见的先天性心脏缺陷已经存在了几十年。然而，与传统正中胸骨切开术相比，既定的外科培训课程中缺乏对该方法的讲授，而且它需要更多的技术专长和一定的学习曲线，这限制了其应用，只有特定专业中心的某些外科医生才会常规开展。最近，通过积累并日益通过媒体传播的共享经验、借助普遍可获取的手术视频和模拟实现的远程教学潜力，这种方法获得了关注和认可，甚至在许多中心已成为新的标准术式。在本综述中我们展示了我们自身经验和方案中随着时间推移不断发展的技术重点内容，同时简要概述了与其他右胸入路相关的文献，并与传统正中胸骨切开术的既定结果进行了一些比较。越来越多的文献，在各大洲更频繁地发表，似乎表明通过微创右胸入路修复先天性心脏缺陷正成为新的标准术式，因为据报道这种方法安全且可重复，手术效果极佳，并且在美容方面明显更优、更令人满意。但这需要外科医生付出额外的培训和经历学习曲线的代价，因为他们在标准专业培训课程中并未学到该技术。
