Developing New Skills for Smaller and Hidden Incisions - Abstract
Background: Minimally invasive cardiac surgery has grown in adult population. However, its application to congenital heart disease in pediatric patients remains limited. In this scenario, alternative minimally invasive approaches have been recently used, but taking a step forward on a video-assisted repair is still unclear. We present the initial experience of a pioneering training animal model program for video-assisted repair in congenital heart defects and new tools for peripheral cannulation. Methods: Phase 1. The ovine model8 sheep was used for training the pediatric cardiac surgeons under the supervision of expert endoscopic surgeons.Phase 2. Patients
2 pediatric pacientes with ASD underwent video-assisted repair (aditional port) by submammary and axillary regular approaches. New skills for peripheral cannulation were developed: Echo assessment of femoral diameter and percutaneous stitching. Results: 22 patients were enrolled after training in thoracoscopic assistance and peripheral cannulation for cardiopulonary by-pass (mainly ostium secundum atrial septal defects closure). Two patients had their original incision enlarged from 4 to 6 cm. Two complications requiring fasciotomy were recorded. Conclusions: Although the small size of pediatric patients constitutes the main limiting factor for a video-assisted repair, the use of animal models for training in these techniques may be useful. Whereas familiar to surgeons, peripheral cannulation risks cannot be understimated. This training in close partnership with expert pediatric surgeons in thoracoscopic techniques and cardiologists used to percutaneous access is a key point for developing novel surgical skills for those commited to congenital heart defects.