Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3753_Библиотеки_им_академика_М_И_Перельмана
.pdf
Endoscopic
Cardiac
Surgery
Tips, Tricks and Traps
JosephZacharias
Editor
123
Endoscopic Cardiac Surgery
Joseph Zacharias
Editor
Endoscopic Cardiac
Surgery
Tips, Tricks and Traps
123
Editor
Joseph Zacharias
Lancashire Cardiac Centre
Victoria Hospital
Blackpool, UK
This work contains media enhancements, which are displayed with a “play” icon.
Material in the print book can be viewed on a mobile device by downloading the
Springer Nature “More Media” app available in the major app stores. The media
enhancements in the online version of the work can be accessed directly by authorized
users.
ISBN 978-3-031-21103-4 ISBN 978-3-031-21104-1 (eBook)
https://doi.org/10.1007/978-3-031-21104-1
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my late father Zacharias Vellapally George, who succumbed
to heart disease too early in life, and my mother Lily George,
who believed in me, more than I ever did.
Foreword
Medicine is all about care, Cardiac Surgery is about care and ... dare!
The first pioneers in the middle of the twentieth century epitomised this
adage. Hundreds of cardiac surgeons all over the world took advantage
of their pioneering and panache. More so, it allowed them to thrive on a
stream of patients that badly needed this daring surgery to survive, whatever
it meant in terms of invasiveness.
Some thought that the “midstream flow” with surgery through a classical
mid-sternotomy access would never come to an end.
But then, a new era of possible treatments for cardiac disease came up
with a variety of different treatment options for:
Revascularisation (Bypass vs. PCI)
Aortic Valve Procedures (AVR vs. TAVI)
Mitral Valve Procedures (MVRepair vs. MitraClip)
Aortic Diseases (Operation vs. Stent)
Electrophysiology (Thoracoscopic Ablation vs. PVI).
Not only did we see a great number of interventional cardiologists put a lot of
effort into the improvement of all these catheter-based techniques, but also
the industry poured lots of money into the creation of start-ups to venture
brand new techniques that particularly challenged the surgical techniques
with one adage: perfect cosmetics, virtually no pain and immediate rehabilitation, particularly for a growing number of older and more frail patients,
for which surgery remained pretty invasive.
In the twentieth century, the saying was: no pain without gain.
In the twenty-first century, it became: whatever gain, but certainly without
pain.
As a result, the number of coronary artery bypass grafting, and aortic
valve procedures decreased.
A number of pioneering surgeons realised that in one area, namely the
reconstructive surgery of the mitral valve, there wasn't a lot of competition
with the excellent results of the repair techniques that surgeons had developed over two decades as it is the best treatment that one can offer to younger
patients with a failing degene rative mitral valve apparatus. There was one big
improvement to be made though: our impact on the patients in terms of
invasiveness had to be way better.
vii
viii Foreword
In the late nineties, many techniques were developed to do much less
invasive cardiac interventions but … with all the respect of the high
long-term quality of a pure surgical repair. It led to complete endoscopic
surgery with obvious advantages versus the standard median sternotomy
techniques:
Less trauma and pain
Less blood-air interface
Less sequestration of white cells in the lungs
Less blood loss
Less wound infections
Shorter rehabilitations and
Way easier redo-surgeries.
As these efforts were heavily criticised in the beginning by conservative
surgeons, it took ten years for younger surgeons to realise that this was the
way to go to compete with or—even better—“complete” catheter-based
techniques.
The faith of totally endoscopic surgery was born: do not touch or harm the
bony structure of the thoracic cavity as it was the only way to result in
reduced intensive care unit and hospital length of stay postoperatively;
patients are monitored overnight in the intensive care unit. Chest tubes can be
removed after 24–36 h.
It was a lot about “daring” though as we were not allowed to offer
mediocre results let alone more risk than before.
With many lessons learned from the pioneers, a growing number of young
surgeons adapted very well to these disruptive gestures, performing
remarkably well, keeping in mind these gold rules:
Create Your Team: failing to prepare is preparing to fail
Seldinger Cannulation is crucial for ECC installment
Be extremely meticulous with Myocardial Preservation
Surgery remains exposure, even more so in small access surgery
Practice endoscopic Surgery and Shafted Instruments Skills.
The true non-rib spreading technique limits scar, discomfort and physiologic
responses of the intervention, ensures a two weeks rehab-period and comes
very close to the “puncture-hole, no pain, no rehab qualities” of percutaneous
gestures but with a long-term repair-for-life result in a very high percentage.
The Credo is, an excellent mitral valve repair is pure gold for a patient, but
always go for it with minimally invasive techniques that can compete with or
be a complement for the interventional cardiologist.
In conclusion, totally endoscopic surgery is a great asset for the surgeon in
times where trans-catheter techniques become widely adopted and are often
the first choice for the patient of the twenty-first century.
Foreword ix
This book is a very remarkable document for all cardiac surgeons who
want to become less invasive and it should be first-class inspiration for young
surgeons: a must read and a professional companion for the rest of their
careers.
Hugo Baron Vanermen
Founder and Head of the Cardiac
Surgery Department (1980 [ 2013)
OLVZ-Aalst
Aalst, Belgium
Endoscopic Mitral Valve Surgeon and former
consultant for MICS
@ Klinik Im Park, Zurich, Switzerland
@ Clinica St-Anna, Catanzaro, Italia
@ Institut Mutualiste Montsouris, Paris, France
@ LUMC, Leiden, the Netherlands
@ UCL, St Luc, Woluwe, Belgium
@ AZ, VUB, Brussels, Belgium
@ European Hospital, Roma, Italia
@ Policlinico di Monza, Italia
Preface
There are more books being published every year today, and than can be read
by a particular individual. Why then did SpringerNature decide to embark on
this one? That would be a very good question to try and answer right at the
start. Surgeons are a lot like Chefs. We often have a similar recipe but add
our own individual touch to make each procedure slightly different and
unique. The finished product may be similar but there are always subtle
variations in how we achieve the final result. Of course like chefs, we are
influenced by the culture we are working within and societal constraints of
what is funded and accepted. Herein lies the big challenge for all those who
would like to see surgery standardised. Even though we are making progress
on this front, we in cardiac surgery are a while away from getting there. This
book was put together to mirror a “cookbook” rather than a “textbook” of
techniques in a new emerging and exciting subspecialty of cardiac surgery!
On this background of variation, the introduction of endoscopic techniques within cardiac surgery has been a challenge across the globe and even
though it is widely recognised as potentially the least invasive way of
achieving good long-term results in cardiac pathology, the reality of introducing this into practise, making it safe and reproducibl e in the hands of a
critical mass of surgeons, has been elusive. The reasons for this may be
multifactorial, but need to be considered in order to overcome.
The first obvious reason is the already excellent results that a sternotomy
approach brings to deal with a diverse set of cardiac pathology and as these
techniques have been around for over 50 years, there is an excellent training
program in many countries to get young surgeons from beginners to a fully
trained cardiac surgeon which takes from 3 to 8 years depending on the
country and exposure available. Over the past 30 years, there has also been a
genuine hope that trans-catheter procedures will provide an alternative, and
these procedures have been funded and adopted widely in many health
systems to varying degrees of success. There is now an increasing accept ance
that trans-catheter procedures and conventional cardiac surgery are in a
“positive sum” game rather than a “zero sum ” game as previously envisioned
by some. As we cardiac surgeons are increasingly getting involved with
patients who are asymptomatic or old and frail, there is a need for a less
invasive incision than a sternotomy.
An endoscope has revolutionised many sub-specialities of surgery, and its
time to do so in cardiac surgery is ripe. I believe this, because we are now
increasingly supported by not only improved images both preoperatively
xi
Соседние файлы в папке Библиотека им академика М.И. Перельмана