Surgical Procedures

About Minimally Invasive & Robotic Cardiac Surgery

Traditionally, open heart surgeons have reached the heart through a sternotomy, a full incision of the breastbone that averages 9-10 inches in length. While this approach offers complete access to the heart, it extends the post-operative recovery period since the patient's breastbone must heal. In minimally invasive surgery, surgeons reach the heart through smaller incisions, or "windows," that provide access to only the section of the heart being operated upon. The goal of all minimally invasive procedures is to lessen postoperative pain, minimize scarring, and reduce recovery times versus traditional open procedures.

A variety of surgical approaches are available within minimally invasive surgery. A minithoracotomy is an approximately 2-inch incision made between the ribs, eliminating the need for bones to heal postoperatively. A hemisternotomy is a modification of a sternotomy, employing a smaller, 4-5 inch incision of the breastbone. Robotic cardiac surgery is another specific type of minimal access surgery. Surgeons make three very small (1/2 inch) incisions, placing flexible surgical instruments through two incisions, and a camera through the third. The surgeon then controls the instruments at a separate console.

The heart is visible through the 2-inch right minithoracotomy incision above.

Right Minithoracotomy

At Columbia, the right minithoracotomy has become the standard approach for several cardiac operations previously performed only via median sternotomy (full breastbone incision). The approach involves a 2-inch incision between the ribs in the right chest, and minimizes trauma while allowing excellent access to the heart. Examples of operations that we routinely perform through this incision include include mitral valve repair/replacement, atrial septal defect repair, cardiac tumor resection, tricuspid valve repair, atrial fibrillation surgery, or any combination of these procedures.

Left Minithoracotomy

As with the right minithoracotomy, the left minithoracotomy offers minimally invasive access to the heart for procedures that previously required much lengthier incisions. We typically employ a left minithoracotomy for minimally invasive off-pump coronary bypass and cardiac resynchronization therapy for heart failure.

Hemisternotomy

A partial incision of the breastbone, a hemisternotomy offers an alternative to the median sternotomy or full incision of the breastbone. The smaller incision allows access to the aortic valves for aortic valve replacement surgery, while decreasing the risk of sternal wound complications.

Robotic (Totally Endoscopic) Cardiac Surgery

Columbia surgeons have the largest U.S. experience in robotic cardiac surgery. Robotic surgery employs several very small incisions that provide access for the robotic instruments and a camera. The robot's wrists hold the tools, providing human-like range of motion and mimicking the motions made by the surgeon, sitting at the console in the operating room. The robotic cardiac surgical team at NYPH/Columbia currently performs the following procedures:

• Robotic atrial fibrillation surgery
• Minimally Invasive & Robotic Atrial Septal Defect (ASD) Repair
• Robotic biventricular pacing for heart failure
• Robotic MiniThoraCAB (minithoracotomy off-pump coronary artery bypass)
• Minimally invasive & robotic mitral valve repair
• TECAB (robotically-assisted, totally endoscopic coronary artery bypass)
• Robotic thoracoscopic surgery of the lungs, esophagus, and mediastinum