| More and more patients and surgeons focus on the minimally invasivesurgical techniques in the21st century. Totally thoracoscopic operationprovides another minimal invasive surgical method for patients withcongenital heart disease. Totally thoracoscopic surgery (TTS) techniques areused widely and safely in treatment of patients who are with congenital heartdiseases now. As a great technological advance from totally thoracoscopicsurgery, it can be performed easily, provides an alteration for patients whowith ASD or other congenital heart diseases.TTS offers a minimally invasive platform for most cardiac operations suchas ventricular septal defect repair, atrial septal defect repair, etc. TTS hasstrengths and drawbacks. The success depends on appropriate hardware setup,staff training, and troubleshooting efficiency.Totally thoracoscopic surgery is a platform that provides less incisionaltrauma but equivalent corrective procedures for cardiac lesion as conventionalmedian sternotomy(MS). It is one of the techniques of minimally-invasivecardiac surgery (MICS) that minimizes incision size in order to lowermorbidity while preserving quality in carefully selected patients. Comparedwith direct vision in minimal access approach, video scope may offer smallertrauma, larger images, brighter illumination, and easier recording andbroadcasting. TTS require more learning curve for hand and eye coordination.Thoracoscope can only offer two-dimensional imaging which is a weaknessrelatively to direct vision.Since June2012,12consecutive patients underwent VSD and ASD closingwith the totally thoracoscopic technique in our hospital. In our study, wereported the follow-up results in these patients and our experience of thistechnique. We welcome both novice or expert audience，this research may not be comprehensive but will serve as reminders and highlights.Objective: To investigate the differences between totally thoracoscopicsurgery and conventional median sternotomy in operating time, clinicalrecords after the surgery, the bypass time and other related records. And findout goodness and weakness by comparing the two methods for the surgeries torepair cardiac septal defect.Methods: Twenty five patients with ventricular septal defect (VSD) andatrial septal defect (ASD) were randomly divided into two groups according tooperative methods. In the TTS group, twelve patients were repaired withtotally thoracoscopic technique. They were adopted opening holes in thorax;the arterial catheter and the venous catheter were placed in the right femoralartery and femoral vein to set up CPB. In the MS group, thirteen patients wereoperated by conventional median sternotomy with cardiopulmonary bypass.Their breast bones were opened from up to down, the arterial catheter and twovenous catheters were placed in the aortic, the superior vena cava and interiorvena cava to set up CPB. The clinical records from two groups were comparedon the length of operation time(min),the postoperative mechanical ventilationtime(min),days of coming back to the ordinary wards, days of postoperativehospital stay, the chest drainage (ml) in the first24hours, the amount of bloodsupplied(ml),the frequencies of postoperative pain medication (Morphine andrelated drugs),days of using antibiotic, the bypass time(min),aortic clamptime(min) and other related records.Result: The mean age of TTS patients was31.08±12.14years; the meanweight of TTS patients was59.29±15.07kg. The procedures performedincluded atrial septal defect repair in11patients and ventricular septal defectrepair in1. While the mean age of MS group patients was27.77±12.67years,the mean weight of MS patients was48.42±13.91kg. The proceduresperformed included atrial septal defect repair in13patients.In the TTS group, the median duration of the operation was302.50±42.82minutes. The postoperative mechanical ventilation time was343.33±274.97minutes. The mean days of coming back to the ordinary wards was1.50±0.60 days. The mean day of postoperative hospital stay was7.58±1.62days. Whilein the MS group, the median duration of the operation was260.00±49.49minutes. The postoperative mechanical ventilation time was349.23±191.50minutes. The mean days of coming back to the ordinary wards was1.92±3.44days. The mean day of postoperative hospital stay was9.69±2.25days.In the TTS group, the median length of cardiopulmonary bypass and crossclamp time was87.50±20.96minutes, The frequencies of postoperative painmedication was17%, the mean chest drainage in the first24hours and themean amount of blood of supplied were111.33±86.86ml and400.00±147.70ml,respectively.In the MS group, the median length ofcardiopulmonary bypass and cross clamp time was54.00±10.77minutes, Thefrequencies of postoperative pain medication was42%, the mean chestdrainage in the first24hours and the mean amount of blood of supplied were228.46±105.74ml and692.30±446.20ml, respectively.There were no mortality in two groups; all patients were succeeded inleaving hospital. There were no statistically significant differences betweenthe two groups in the postoperative mechanical ventilation time, days of usingantibiotic and aortic clamp time(P＞0.05).As compared with the conventionalMS group, the TTS group had a longer length of operation time(P＜0.05),while days of coming back to the ordinary wards and days ofpostoperative hospital stay were shorter in TTS group than that in MS group(P＜0.05).In the TTS group the wound was remarkably alleviated, the chestdrainage in the first24hours and the amount of blood of supplied werefewer(P＜0.05). The frequencies of postoperative pain medication (Morphineand related drugs) were fewer in the TTS group than in the MS group, whileTTS patients had longer bypass time than MS patients(P＜0.05).Conclusions: Although in the initial of thoracoscopic operation, the lengthof operation time and the bypass time were longer than conventionalsternotomy, the TTS remarkably has the advantages of alleviating the wounds,earlier recovery, less pain, fewer blood transfusion and fewer using of painmedication. The TTS, just like MS, is safe, effective and reliable method in repairing cardiac septal defect disease. |
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