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Chirurgia 2019 October;32(5):228-30

DOI: 10.23736/S0394-9508.18.04893-3


language: English

Minimally invasive cardiac surgery using three-dimensional computed tomography image projection

Tetsuro UCHIDA , Mitsuaki SADAHIRO

Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan

BACKGROUND: Minimally invasive cardiac surgery via small intercostal thoracotomy is a less invasive treatment for cardiac diseases. Despite many advantages, it is challenging for cardiac surgeons because of limited mobility due to the small skin incision and surgical field. To optimise the setup and instrument placement for surgery, we developed a preoperative image overlay technique using three-dimensional (3D) computed tomography (CT) image projection on the patient’s body surface.
METHODS: Under general anaesthesia, a reconstructed 3D-CT image was directly projected onto the patient’s skin. The clavicle and lower costal edge were used as references to fit the CT image. Since December 2010, 32 patients have undergone minimally invasive cardiac surgery using this technique, including aortic valve replacement in 16 patients, mitral valve plasty in 2, atrial septal defect closure in 11, and foramen ovale closure in 3.
RESULTS: None of the treated patients experienced complications. No operative or in-hospital deaths were noted. Based on the preoperative image overlay projection findings, the appropriate site of cannulation, traction suture placement, and manner of aortic occlusion were precisely predicted and performed. These aspects of preoperative planning were useful in obtaining good surgical exposure without the need for intraoperative conversion to standard sternotomy.
CONCLUSIONS: Image overlay projection allows surgeons to view underlying anatomical structures virtually and obtain a good operative field. Our proposed technique can be expected to make minimally invasive cardiac surgery easier and safer in cases with a small skin incision and surgical field.

KEY WORDS: Cardiac surgical procedures; Minimally invasive surgical procedures; Imaging, three-dimensional; Tomography, X-ray computed

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