Comparative Study between Surgical Repair of Atrial Septal Defect via Median Sternotomy, Right Submammary Thoracotomy, and Right Vertical Infra-Axillary Thoracotomy

Impact of right anterolateral thoracotomy with a new approach on breast development: survey analysis of female cardiac surgery patients

“…10 In the study where Lou et al compared three surgical methods, it was emphasised that right submammary thoracotomy should be avoided in young female patients due to its potential to damage to the breast tissue and chest wall muscles, especially when applied at younger ages, the incision should be made as far away from the breast tissue as possible to avoid development insufficiency of the tissue in future breast development. 11 The point where we agree on with this study is; We made the skin incision at least 4-5 cm (approximately sixth intercostal space) below the nipple and aimed to minimise the damage to the breast tissue. We strongly suggest the location of the incision in the submammary region needs to be very low under the right nipple (above the fifth-sixth intercostal space).…”

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

“…3,4,6,7,[10][11][12]16,20,[24][25][26]28 The suggested advantages of the mini right axillary incision include: (a) a musclesparing approach with resultant shorter recovery time and return to full capacity of the right arm and shoulder function, as only longitudinal muscle fibres of the serratus anterior are split parallel to the ribs; (b) avoidance of breast tissue, which is especially important in young female infants given the absence of any visible landmark at the time of surgery, thus avoiding future asymmetrical breast growth; (c) a completely hidden scar underneath the resting arm, resulting in a superior cosmetic appearance in comparison with any other thoracic incision. [1][2][3][4][5][8][9][10][14][15][16][17][19][20][21][23][24][25][26][27] As with introducing any new technique, during the early development of the minimally invasive right axillary approach, our goal was to demonstrate its safety, and reproducibly match standard hospital outcomes or even improve upon them, compared to surgery through a conventional median sternotomy. Several reports from groups who perform variations of our minimally invasive technique have presented similar if not better data related to the length of tracheal intubation, duration of need for chest drains, requirement for blood transfusion, duration of ICU and hospital length of stay, [1][2][3][4][5]…”

“…[1][2][3][4][5][8][9][10][14][15][16][17][19][20][21][23][24][25][26][27] As with introducing any new technique, during the early development of the minimally invasive right axillary approach, our goal was to demonstrate its safety, and reproducibly match standard hospital outcomes or even improve upon them, compared to surgery through a conventional median sternotomy. Several reports from groups who perform variations of our minimally invasive technique have presented similar if not better data related to the length of tracheal intubation, duration of need for chest drains, requirement for blood transfusion, duration of ICU and hospital length of stay, [1][2][3][4][5][8][9][10][14][15][16][17][19][20][21][23][24][25][26][27] as confirmed in our current study. The two patients requiring reoperations during the same hospital stay merit a discussion regarding optimal pre-operative imaging, considerations with regards to cannulation, and sufficient exposure required for an optimal repair.…”

“…Together with enhanced anaesthesia pain management protocols, various surgical incisions such as a right horizontal or vertical axillary thoracotomy, and the anterolateral thoracotomy have been compared to the conventional median sternotomy, and aim not only to improve cosmetics, but merit consideration to reduce post-operative pain and discomfort, achieve faster post-operative functional recovery, and perhaps decrease hospital costs. While the duration of ICU and hospital stay, as well as chest drain output and blood transfusions, have extensively been studied after minimally invasive techniques, 3,4,[6][7][8][9][10][12][13][14]17,19,21,[23][24][25][26][27] to the best of our knowledge, only one group evaluated pain and comfort of patients in the immediate post-operative period, and subsequent quality of life. 29 In our single-centre study, we sought to evaluate the quality-of-life metrics by comparing paediatric congenital heart repairs through a mini right axillary thoracotomy, with children undergoing repair of similar defects through a median sternotomy.…”

Results of thoracoscopic correction of atrial septal defect with cardiopulmonary bypass

“…На протяжении многих лет стандартным подходом к хирургическому лечению ДМПП оставалась срединная продольная стернотомия, которая обеспечивает широкий доступ к сердцу. Однако у данного метода имеется ряд недостатков: большая травматичность, удлинение пребывания больного в стационаре, вероятность развития инфекционных осложнений, грубый послеоперационный рубец [4].…”