19 Feb 2009

NEW DELHI: In what is claimed to be the first of its kind procedure in the country, doctors at Indraprastha Apollo hospital have used a minimally invasive technique to perform a multiple graft heart bypass surgery on a 53-year-old woman without cutting through a single bone.

The new procedure, doctors claim, is less painful than conventional bypass surgery and leads to much faster healing. "This is the first time in India multiple grafts have been put, especially at the backside of the heart, through minimally invasive coronary surgery (MICS CABG). In conventional bypass, the sternum is cut open and that takes at least 6-8 weeks to heal. In the new method no bone is cut," said Dr Naresh Trehan, senior cardiovascular and thoracic surgeon, Indraprastha Apollo hospital.

The new procedure can be performed on any patient needing a coronory bypass and would be especially helpful for diabetics, who take longer to recover from conventional surgery, Dr Trehan said.

The surgery was performed on Suman Singhal, who was rushed to Apollo after she had radiating pain in her left arm and was diagnosed with multiple blockages last week. Suman was informed about the new technique and was quick to give her consent. "The cosmetic damage is very less. In women, one can't even see the scar as it is below the breast. We procured specialized instruments on Friday and operated on her the next day," said Dr Trehan.

Three incisions were made, two of which were used to insert the equipment that stabilized the heart and from the third the surgeon manually performed the bypass. "The equipment is designed such that the two instruments stabilize the heart. One instrument, called an octopus stabiliser, is inserted from the right side and has a suction pump attached to it. This instrument sucks the heart and stabilizes it. The other instrument, inserted from the left, also helps in stabilizing the beating heart. An 8cm-long incision is made underneath the breast through which we manually put the grafts taken from the internal mammary artery and radial artery," explained Dr Trehan.

The new technique helps put grafts at the backside of the heart. "Accessing the backside of the heart is difficult through minimally invasive surgery. Even in robotic surgery, we can't put grafts at the backside of the heart, but we are developing it further. But here, the instrument that holds the heart is able to rotate it such that the backside is clearly visible to the surgeon," he added.

The advantages over conventional bypass are many, say doctors. "We don't require many blood transfusions. In Suman's case, we didn't require any blood transfusion. The hospital stay is also short as compared to conventional surgery in which the patient stays in hospital for 7-8 days and takes 6-8 weeks for complete recovery," said Dr Yatin Mehta, senior consultant, anaesthesia, Indraprastha Apollo Hospital. This surgery costs less than a conventional surgery "as the number of consumables used are less and hospital stay is just for 3-4 days," said Dr Mehta.

Find out the cost of MICS CABG in India

Read procedure details of minimally invasive coronary artery bypass graft surgery

Acronym: MICS CABG = Minimally invasive cardiac surgery for coronary artery bypass grafting

Source: Times of India