Mini and endoscopic access surgery
Mini sternotomy (vertical incision made in the centre of the chest)
Mini sternotomy is a specialised technique which uses a small vertical incision along the skin in the centre of the chest in order to open the sternum (breastbone). The advantage of this technique is that it produces better cosmetic results without causing risk to the way the surgery is performed. Unlike the conventional sternotomies which extend for a length of 25-30cm and cause an extensive length of tissue damage, mini sternotomy has a length of only 10-15cm and preserves the skin and underlying tissues.
Mini sternotomy leaves the patient with a smaller scar that is located lower than a conventional scar. It can enable the patient to wear a lower neck line garment without fear of the scar showing, and it is often well hidden on men with chest hair or within women’s cleavage. The full cosmetic outcome can be assessed after a period of 3 months when the incision is almost fully healed and incorporated into the patients’ body.
Mini and endoscopic conduit harvesting (Radial artery and leg vein removal)
Minimaly invasive conduit harvesting is a technique used to remove the radial artery from your forearm or the long saphenous vein from your leg using less invasive techniques, so that it can be used as a graft for bypassing the diseased coronary artery of your heart. Conventional techniques involve a long vertical cut which must be made deep into the leg tissues to expose the artery or the vein.
The conventional procedures of harvesting arteries and veins (long incisions) have high rate of complications which can include cellulitis, blood clots, neuralgia and ischemic sequelae, delayed in wound healing, necrosis and infections. These post operative complications are frequently associated with peripheral vascular artery disease, obesity, diabetes, female sex, preoperative steroid treatment, and anaemia. In addition to complications, the patient may experience discomfort from the leg wound that may restrict their mobilisation during the first 6 weeks following the operation.
Minimally invasive – endoscopic conduit harvesting is an advanced method of artery or vein removal, which has a low complication rate and excellent cosmetic results. The artery or vein is removed with the help of special surgical instruments and specialist surgical techniques which ensure that the quality of the removed vein is maintained. This method also ensures that trauma to the patients’ forearms or legs is minimised and blood loss is restricted to an absolute minimum. Patients can put weight on their leg and use their hands on the first day following their operation and mobilise free from the discomfort of long painful leg scars. Healing of the small wounds is complete after 3 months and the cosmetic outcome is very pleasing .
Fully endoscopic arterial and vein harvesting reduces the number of small incisions required to remove the vein, leaving only 2-3 small scars. However, it requires the use of special “single use” equipment at an additional cost to enable the surgical team to harvest the arteries and veins with direct vision. The cosmetic and functional result of this method is the most superior of all techniques used for peripheral arteries and veins harvesting.
- Mid-term outcomes for Endoscopic versus Open Vein Harvest: a case control study. Kirmani BH, Barnard JB, Mourad F, Blakeman N, Chetcuti K, Zacharias J. J Cardiothorac Surg. 2010 May 28;5:44.
- Is it safe to perform endoscopic vein harvest? Tennyson C, Young CP, Scarci M. Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):625-9.