Bypassing ugly scars of surgery

Cardiovascular surgeon Dr Naresh Trehan did another first in India by conducting a triple heart bypass surgery using the minimally invasive technique at Indraprastha Apollo Hospitals, reports Rhythma Kaul.

Cardiovascular surgeon Dr Naresh Trehan did another first in India by conducting a triple heart bypass surgery using the minimally invasive technique at Indraprastha Apollo Hospitals.

“The new technique allows the surgeon to put more than one graft in place without leaving a 6-inch scar running down the centre of the chest. It is done on a beating heart, so it carries the advantages of low infection risk and quicker recovery,” said Dr Trehan.

The triple bypass was done on Suman Singhal, 53, on Saturday, and she will be discharged on Thursday. “A big scar down the centre of my chest would have reminded me of the surgery very day for the rest of my life, but now I cannot see the scars as one is below my breast and the other near th e right underarm. No one can tell that I have undergone bypass surgery,” said Singhal.

The cosmetic benefit of minimally invasive bypass surgery is huge. Instead of cutting the chest bone (sternum) through a six-inch incision to access the heart, two small incisions are made — a small three-inch incision under the breast to access the heart and a small hole on the right corner of the chest for the video-imaging, which allows the surgeon to guide the instruments while watching the procedure on a monitor.

What made the surgery possible was the newly acquired stabiliser, which arrived at Apollo on Friday, a day before the surgery. “To reach the front of the heart — as is done in a normal bypass — is easy. The problem has always been gaining access to the side and back of the heart. The new equipment allows us to lift and rotate the heart, giving surgeons complete access and allowing us to put multiple grafts simultaneously,” said Dr Trehan.

Stabilisation instruments are also used in conventional surgery to lift and stabilise a portion of the surface of the beating heart where the bypass graft is being put. This makes it possible to avoid the use of the heart-lung machine, as the heart continues to pump blood even while the surgery is going on. The stabilising instruments used for the minimally invasive technique are smaller and far more advanced, allowing for greater precision.

It offers benefits like shorter hospital stay, need for less blood transfusion, less pain and lower cost. “Since the chest bone is not cut, the healing process is faster and the patient is discharged in five days at the most, compared to the eight-day hospitalisation needed after conventional surgery,” said Dr Yatin Mehta, senior consultant anaesthesia, who was part of the team that did the surgery.