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Minimally Invasive Cardiac Surgery (MICS)

Minimally Invasive Cardiac Surgery, in other words, Keyhole Heart Surgery, is performed through a small incision, often using specialized surgical instruments. The incision is about 3 – 4 inches instead of the 6-8 inch incision required for traditional surgery allowing the patient to be discharged fast with quicker recovery.  A further sub-specialisation of Minimal Invasive surgery is Robot-assisted surgery where the incision is even smaller, and recovery is even quicker.

Underlying conditions

MICS is an approach to surgery that can successfully treat multiple cardiac conditions

  • Coronary artery disease
  • Aortic valve disease (stenosis / regurgitation)
  • Mitral valve disease (stenosis / regurgitation)
  • Congenital heart diseases

MICS as a choice of treatment

With the evolution of treatment as well as clinical skill, several procedures can now be done using minimally invasive means, namely

  • Minimally invasive bypass surgery (MIDCAB)
  • Endoscopic vein and radial artery harvesting
  • Robot-assisted bypass surgery (Robot-assisted CABG)
  • Minimally invasive aortic valve replacement
  • Keyhole Atrial Septal Defect (ASD) closure

Alternatives to MICS are conventional surgery involving sternotomy (cutting of the breast-bone to access the chest cavity and heart) as well as interventional cardiology procedures (eg: angioplasty for treating coronary artery disease and TAVI for catheter-based aortic valve replacement) where there is no surgery involved at all. A team of cardiologists and surgeons will jointly discuss viable options for you since some approaches can be better clinically indicated for you as compared to others.

How it’s done and what to expect

An MICS procedure is done by making a 3-4 inch incision in the left chest just below the nipple and entering the chest cavity between the ribs without cutting any bones in the process. MICS CABG involves an additional step (as opposed to MICS valve replacement) of harvesting of a combination of arteries and veins from the leg (usually done through minimally invasive means too). Advantages of minimally invasive surgery include.

  • Lower chest wall trauma
  • Minimal surgical scars
  • No broken bones
  • Minimal blood loss and no blood transfusion
  • Shorter hospital stay (4-7 days)
  • Faster mobilization and recovery
  • Lower rate of infection
  • Better success in case of re-op

Robot-assisted surgeries are one step further in terms of low invasiveness. They involve the use of robot arms controlled by the surgeon at a console with an assistant on standby. The size of the incision required is about 8 mm, which significantly reduces chest wall trauma and enables even better recovery and results compared to minimally invasive surgery. The 3D magnified vision offered at the console also affords significantly more precision for the surgeon, which reflects in outcomes.

Robot assisted surgery affords the following additional advantages compared to MICS procedure

  • Even lesser scarring
  • Even shorter length of stay (3-4 days)
  • Even faster mobilization and recovery (1-2 weeks post-discharge)

The Apollo Edge

  • Leader in MICS procedures in AP Telangana (1300+ procedures performed)
  • 1st hospital to perform Robot Assisted Cardiac Surgery
  • Home to Da Vinci XI Robotic system – the most advanced surgical suite in the world
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