Penn Medicine’s Heart Surgery program is a national leader in performing minimally invasive heart surgery. We have performed thousands of these less invasive cardiac procedures and continue to perfect our approach with every year, helping to improve your surgical experience and outcomes so that you can get back to doing the things that you love.
What Is Minimally Invasive (Keyhole) Heart Surgery?
Minimally invasive heart surgery, sometimes referred to as keyhole heart surgery, refers to surgical procedures performed through one or more small incisions in the chest. During minimally invasive cardiac procedures, surgeons guide small cameras, robotic instruments and other surgical tools through the incisions and between the ribs to access the heart.
There are two types of minimally invasive heart procedures:
- Robotic-assisted surgery: Your surgeon will guide robotic arms through one or more small incisions in the side of your chest between your ribs to perform the procedure. The robot is equipped with a camera so your surgeon can get a clear view of your heart.
- Thoracoscopic surgery: Your surgeon will insert a long tube and camera called a thoracoscope through a small incision in your chest and between your ribs to view your heart. The procedure will be performed using long, thin tools inserted through additional or the same incision.
What is the Difference Between Minimally Invasive Heart Surgery and Open-Heart Surgery?
Traditional open-heart surgery is the standard approach for many cases, because it provides your surgeon with clear access to and visualization of the heart. In most cases, this type of heart surgery involves making an incision in the chest through the breastbone (sternotomy). Typically, sternotomy incisions are eight to 10 inches in length.
Minimally invasive heart surgery differs from open heart surgery in its use of small incisions to access the heart. Because minimally invasive surgical procedures avoid a large incision, they are typically less painful and have a quicker recovery period.
Benefits of Minimally Invasive Cardiac Surgery
The benefits of less invasive heart procedures include:
- Reduced pain after surgery
- Lower infection risk
- Less blood loss
- Smaller, less visible scars
- Improved recovery times and shorter hospital stay
- Fewer physical restrictions after surgery
Who Is a Candidate for Minimally Invasive Cardiac Surgery?
Many people are candidates for minimally invasive cardiac surgery and your surgeon may allow you to decide if you want to proceed with a minimally invasive procedure or opt for traditional open-heart surgery. Your care team will discuss the risks and benefits of the operations and explain what is involved to help you make the decision that aligns with your lifestyle and healthcare goals. Once you decide, you will go through an extensive screening process to help lessen any possible complications that may arise.
Before recommending a minimally invasive procedure, your care team will consider:
- Your heart’s condition
- Additional procedures that may need to be done at the same time
- Certain lifestyle factors such as smoking or BMI
- Other medical complications that may make surgery too risky
Patients that are not ideal candidates for minimally invasive heart surgery often have several areas of the heart that would benefit more from an open-heart procedure. For those who do not qualify for or are not interested in minimally invasive procedures, Penn cardiac surgeons have extensive experience in open-heart surgeries.
Treatments Offered at Penn Medicine
Penn’s minimally invasive cardiac surgeons now routinely access the heart through smaller incisions and with specialized surgical instruments using these approaches:
- Mini-sternotomy: a 3-inch incision in the upper part of the breastbone
- Mini-thoracotomy/port access: a 2- to 3-inch incision between the ribs
- Robotic: a 1.5- to 2-inch incision and two to four small port sites
Penn cardiac surgeons perform these less invasive alternatives to open-heart surgery:
Catheter-Based Procedures
Our cardiac specialists perform catheter-based procedures for heart conditions. This approach uses a tiny incision, usually in the groin. Specialists thread a catheter (a small tube) through a blood vessel into the heart. Next, they deploy life-improving devices through the catheter directly into the heart. Examples of treatments include:
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
For patients with severe coronary artery disease, Penn Medicine's surgeons provide a less invasive alternative to coronary artery bypass graft (CABG). During MIDCAB surgery, your surgeon uses smaller incisions and performs the procedure as your heart beats, so the cardiopulmonary bypass machine (heart-lung machine) is unnecessary. MIDCAB effectively reroutes blood flow around damaged heart arteries (revascularization) like a CABG procedure but with the benefits of minimally invasive surgery.
Penn’s heart surgeons are some of the most experienced in the region in performing this technically challenging procedure. In most cases, we perform the procedure with robot assistance.
Robotic Heart Surgery
Robotic heart surgery, sometimes called DaVinci surgery, is a minimally invasive approach to surgery where surgeon-controlled robotic devices, cameras and precision instruments are used to perform intricate procedures on the heart. The use of a robot may increase precision and safety because it allows for micro-movements that are not possible with the human hand. The robot also increases visualization of the heart beyond what is possible with the human eye.
Like other minimally invasive cardiac procedures, surgeons do not have to cut through the breastbone to access the heart. Rather, robotic instruments and cameras can be inserted through small incisions between the ribs.
To perform robotic heart surgery, your surgeon:
- Creates several incisions between the ribs.
- Inserts instruments through the incisions into the chest cavity.
- Sits at a console and uses a camera attached to one of the instruments to view high-definition 3D images of the heart.
- Uses the console to control the robotic arms, which move the instruments to perform the procedure.
Our highly skilled minimally invasive cardiac surgeons use the robot to treat:
Recovery from Minimally Invasive Heart Surgery
For most people, minimally invasive cardiac surgery has a quicker recovery period than open heart surgery. Because your incisions are smaller, you can expect a shorter hospital stay, with less pain and fewer movement restrictions following surgery.
After your minimally invasive cardiac procedure, you will be transferred to our specialized cardiac intensive care unit for recovery. There, you will be monitored by a highly trained team who will provide skilled care 24 hours a day.
Once you are able, your care team will encourage you to move around as much as possible during your hospital stay. Most patients can expect a two to five-day hospital stay following minimally invasive heart surgery. During that time, your team will set movement goals and a respiratory therapist will teach you breathing and coughing exercises to help keep your lungs clear.
Once you are discharged from the hospital, your care team will offer guidance on rest, incision care, medication and follow-up appointments. You may also be recommended to attend cardiac rehabilitation to help you regain strength and stamina.
Minimally Invasive Cardiac Surgery: Why Choose Penn Medicine
At Penn Medicine, our surgeons and clinicians remain at the forefront of minimally invasive cardiac surgery by practicing the latest techniques. At Penn Medicine, you can expect:
- World renowned experience: Penn cardiac surgeons are innovators in their field. They develop new techniques and procedures to help improve outcomes.
- Industry-leading hybrid operating rooms: We offer state-of-the-art facilities with the latest technologies. Our hybrid operating rooms offer advanced imaging capabilities. In this state-of-the-art suite, your care team can perform catheter-based procedures, minimally invasive surgical procedures and traditional operations. The benefit for patients is that specialists can perform multiple procedures at one time.
- Care close to home: Penn cardiac surgeons see patients in satellite locations across the community allowing convenient consultations, second opinions and pre- and post-operative care close to home.
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