Challenges and Limitations of Minimal Invasive Cardiac Surgery
Minimal-invasive cardiac surgery (MICS) has gained popularity as a less invasive
alternative to traditional open-heart surgery. While MICS offers numerous
advantages, including shorter hospital stays and faster recovery times, there
are also challenges and limitations associated with these techniques. This
article aims to discuss the challenges that surgeons may face when performing
minimal invasive procedures and the limitations of this approach.
Challenges of Minimal Invasive Cardiac
surgical field: One primary challenge of MICS is the limited exposure of the
surgical field. Compared to open-heart surgery, MICS requires smaller
incisions, leading to a restricted view of the heart and surrounding
structures. This limited access can make it challenging for surgeons to perform
complex procedures or manipulate delicate tissues.
Technical expertise: Performing MICS requires advanced technical
skills and specialized equipment. Surgeons must be proficient in using
video-assisted technologies and operating through small incisions with precise
movements. The learning curve for these techniques can be steep, requiring
extensive training and experience.
Instrumentation limitations:The instruments used in MICS are specifically
designed for the minimally invasive approach. However, these instruments may
have limitations in terms of maneuverability and functionality compared to
traditional open surgery instruments. The restricted range of motion can pose
challenges when performing intricate procedures.
Patient selection:Not all patients are suitable candidates for
MICS. Factors such as previous surgeries, anatomical variations, or complex
cardiac conditions can make it difficult to perform minimal invasive
procedures. Surgeons must carefully evaluate each patient to determine their
eligibility for MICS and decide whether an open approach is more appropriate.
Limitations of Minimal Invasive
to complex cases: MICS is well-suited for specific cardiac conditions, such as
isolated valve repair or small coronary artery bypass grafting. However, it may
not be the preferred approach for more complex cases, such as multiple valve or
coronary artery disease. In these situations, open-heart surgery may still be
necessary to ensure optimal outcomes.
Learning curve and cost: MICS techniques and equipment require
additional training and investment. Surgeons need to undergo specialized
training to become proficient in minimal invasive procedures. Additionally, the
cost of equipment and instrumentation associated with MICS can be higher than
traditional open surgery, which may limit its availability in certain
Increased operative time: Performing MICS often requires more setup
time and meticulous surgical techniques, which may result in longer operative
times compared to open-heart surgery. The extended duration of surgery can
increase the risk of complications and may not be suitable for patients with specific
Conversion to open surgery: During a MICS procedure, there is a
possibility that unforeseen circumstances or complications may require the
surgeon to convert to an open surgery approach. In cases where the minimal
invasive technique becomes technically challenging or unsafe, converting to
open surgery may be necessary to ensure patient safety.
Dr. Sanket Garg
Sr. Consultant - Cardiac Surgeon
Metro Hospital & Heart Institute, Meerut UP