I have been performing minimally invasive surgery for 9 years. The most important take away point about exposure is to stay calm and be patient during each step of the procedure (I guess that holds true for any surgery). Upon entering the thoracic cavity from a mini thoracotomy approach, the initial impression is that it will be impossible. Keep in mind that each step in the operation will provide the next exposure thus facilitating the procedure even further. Once CPB is instituted, the visualization becomes more familiar. So if one feels anxious at any point during the exposure, “go on pump” and move along.
There is no doubt that our eyes and brains were not initially trained to expose the aortic and mitral valve via a more lateral approach. It is also interesting to note that in 1956, Dr. Walton Lillehei, one of the pioneers of Cardiac Surgery, claimed that exposure of both the mitral and aortic valves was excellent via a thoracotomy approach. The birth of minimally invasive mini thoracotomy surgery was truly ahead of its time. Where and why was the evolution steered off track?
I believe, we need to be part of the Re-Evolution of Cardiac Surgery and further develop minimally invasive cardiac surgical techniques. Our patients deserve the benefits afforded by this procedure.