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Keyhole bypass: Cutting edge today, conventional tomorrow?

Keyhole vs. conventional bypass surgery: A quick comparison

KeyholeConventional
  • 3- to 5-inch incision(s) between ribs
  • possible to operate on beating heart
  • limited to blockages in main arteries
  • typically performed without heart-lung machine
  • hospital stay: 4–6 days
  • recovery: 7–10 days
  • technology developing
  • long, vertical incision through breastbone
  • heart must usually be cooled and stilled
  • treats single or multiple blockages
  • typically requires heart-lung machine
  • hospital stay: 7 days
  • recovery: 6–8 weeks
  • performed since 1967

Chances are, you or someone you know has had some form of laparoscopy. Perhaps a friend had his gallbladder removed without a six-inch scar to show for it, or your sister-in-law had laparoscopy to diagnose a pelvic problem. In any case, you’re probably familiar with the minimally invasive procedure in which surgeons operate through one or several keyhole-size incisions. In addition to surgical instruments, a small video camera is slipped through one of the tiny openings to give surgeons a magnified view of their work.

Revolutionary just a few years ago, routine today. And now cardiac surgeons are using minimally invasive techniques on the heart. The techniques have names such as MIDCABG (minimally invasive direct coronary artery bypass grafts), keyhole CABG or MICABG (minimally invasive coronary artery bypass grafts) or mini-CAB.

Here’s how they work. While conventional bypass surgeries require vertical cuts through the entire length of the rib cage, the new “keyhole” methods require just a small incision (or a series of incisions) between the ribs. Not only do these keyhole methods leave smaller scars, they also make for quicker and less painful recoveries.

What’s more, keyhole surgery often makes it possible for surgeons to perform on a warm, beating heart. Traditional bypass operations, on the other hand, usually require surgeons to cool and chemically stop a patient’s heart, rerouting the blood through a heart-lung machine.

Although keyhole bypass techniques are an exciting development, they’re not for everyone. People with multiple blockages, for example, are not candidates. But the new procedures can be used to help patients with a blockage in a main artery.

And for people for whom traditional bypass surgery may be too risky—the elderly, those with complications such as kidney failure and patients who have already had bypass surgery—keyhole bypass may well be a godsend.


© 2014 Dowden Health Media