Doctors at a seminar on paediatric cardiology at Amrita Institute of Medical Sciences highlight the importance of conducting minimally invasive heart surgery in children
Cosmetically appealing heart surgery in children is increasingly becoming popular. Advancements such as laparoscopic surgery and robotic surgery now allow for smaller and smaller incisions, enabling heart surgeries which hardly leave any visible scars. Even these small incisions can be hidden in unexposed areas of the body, such as in armpits. It is now very much possible for children with low-risk cardiac diseases to opt for cosmetic cardiac surgery and live the rest of their lives with a scar-free body, said doctors attending a seminar on paediatric cardiology at the Amrita Institute of Medical Sciences.
Surgeons have traditionally avoided such cosmetic approaches to paediatric heart surgery because operating on children’s heart is considered much more challenging than adults. Their hearts are a lot smaller and heart problems typically more complex. Most surgeons stick to the traditional approach of splitting open the chest using a large incision. The resulting midline scar is a source of considerable embarrassment to the growing child, particularly girls, in their adolescence. it serves as a lifelong reminder of having undergone a heart operation in early childhood.
Said Dr. R. Krishna Kumar, Head, Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi: “Since the social stigma attached to having had a heart problem is considerable, more and more parents are now asking for ways to correct heart defects in their children without the telltale midline scar on the chest. Paediatric heart surgeons have now started to explore ways to correct some heart defects through cosmetically appealing approaches by leveraging latest technological advances. These approaches have the potential to speed up patient recovery and reduce the lifelong psychological trauma from a visible surgical scar. In the coming years, increasing numbers of children are likely to undergo these operations for simple heart defects. The results are typically as good as the traditional approach of open surgery.”
Added Dr. Brijesh P Kotayil, Associate Professor, Department of Paediatric Heart Surgery, Amrita Institute of Medical Sciences, Kochi: “One approach towards minimally invasive cardiac surgery is from the back of the right side of the chest, known as ‘Limited Posterior Thoracotomy’. The scar is limited to the back of the chest just below the right shoulder blade and is completely invisible from the front. Unlike the traditional ‘front of the chest’ approach, no bones are cut. Late problems with posture are uncommon because most chest wall muscles are well preserved. A thousand operations have already been performed at Amrita Institute of Medical Sciences using the approach of Limited Posterior Thoracotomy, with excellent cosmetic results.”
Recently, the surgeons at Amrita Institute of Medical Sciences have gone a step further. They have approached the heart via the armpit (axilla). This procedure hides the surgical scar entirely within the armpit. Further, it spares the ribs and major chest wall muscles, thereby allowing rapid healing and recovery. In fact, with newer and advanced instruments, the surgical scar can be reduced to as small as five centimeters. The first six cases in India using the trans-axillary approach were successfully done at the Amrita Institute of Medical Sciences.