The ability to perform operations using small incisions (called minimally invasive surgery) has developed in many surgical specialties during the last decade. At CVTSA, our cardiac, vascular and thoracic surgeons frequently use minimally invasive approaches to care for patients from across the Washington, DC metropolitan area.

 

When a minimally invasive approach is used, the patient receives the same operation as they would with a large incision. The only difference is in the approach and the tools used to perform the surgery. A small incision can be made because new instruments allow surgeons complete access and visibility through a smaller incision. Once the surgical site is reached, the same techniques are deployed to repair the patient’s disease.  Below you can see the traditional, open approach versus the minimally invasive approach for cardiac surgery.

 

 

While different operations are performed for cardiac, vascular or thoracic patients, the benefits of minimally invasive surgery apply to all three. These benefits are less post-operative pain, shorter length of stay in the hospital and faster recovery time. Further, for cardiac surgery patients, the breast bone does not have to be broken and for thoracic surgery patients, the ribs do not have to be spread. Thus, the most painful part of patients’ recovery is eliminated.

 

 

Minimally Invasive Surgery for Heart Valve and Atrial Fibrillation

At CVTSA, surgeons have been performing minimally invasive surgery since 1997 as a participating center in the Heart Port Trials, the seminal studies for minimally invasive cardiac surgery. For a number of years, minimally invasive mitral valve surgery involved the use of the DaVinci robotic surgical system. Using the robotic system helped surgeons visualize the operative field and learn to work through a small incision. Now, surgeons at Inova have moved to a direct minimally invasive approach using specialized instruments to complete the mitral valve repairs, aortic valve replacement and surgery for atrial fibrillation.

 

 

As seen in the image above, patients who once had to endure having their breast bone broken, long incision scars and painful recoveries now have an incision only five to six centimeters in length. Patients also benefit because those who under minimally invasive heart surgery experience less tissue damage, less blood loss and potentially shorter time on the ventilator after surgery.

 

Not all patients are candidates for minimally invasive surgery. For example, patients undergoing multiple cardiac procedures at the same time will require traditional open chest surgery. Your surgeon will discuss your specific disease with you to determine the most appropriate operative approach. For detailed information about mitral valve and aortic valve disease and atrial fibrillation, please follow the links to those sections of this website.

 

 

Minimally Invasive Thoracic Surgery

Thoracic surgery is surgery in the chest involving the lungs, esophagus, mediastinum and pleura. Traditional thoracic surgery meant a large incision from the front to back of the patient and spreading the patient’s ribs to access diseased tissue. Minimally invasive surgery allows a surgeon to make two incisions which are about two to four centimeters long and then perform the operation without the need for rib spreading. A camera is inserted into one incision and projects the inside of the body onto a 26 inch flat screen high definition monitor. The surgeon watches the screen while inserting instruments through the second incision and performing the surgery. This surgery is sometimes called video assisted thoracic surgery, or VATS.

 

In addition to previously mentioned advantages of minimally invasive surgery, patients who undergo a thoracic operation for cancer are afforded a faster recovery which leads to more successful initiation and completion of adjuvant chemotherapy.

 

To learn more about diseases of the thoracic cavity, click here.

 

 

Endovascular Aneurysm Repair

The diagnosis of aneurysms of the thoracic and abdominal aorta has continued to improve due to more accurate non-invasive screening techniques. At the same time, the risk and complications from surgical treatment have dramatically decreased in large part because of the development of stent grafts which can be deployed using minimally invasive techniques.

 

At CVTSA, surgeons perform the highest volume of endovascular thoracic and abdominal aortic aneurysm repairs in the region on both emergent and elective patients. As seen in the image below, a small incision is made in the groin and the diseased area is accessed from there. 

 

 

We are pleased to utilize many of the commercially available FDA approved devices. Further, our participation in a number of clinical trials allows patients access to unique investigational and trial-approved devices as well.

 

Each patient is individually evaluated to determine what approach is best for their condition. For patients who are not candidates for a minimally invasive intervention, we perform open abdominal and thoracic aneurysm repair. For more detailed information, follow the links to the abdominal and thoracic aneurysm sections of this website.