Impact Of Incision Size

For years, the physical and emotional impact of a large incision size on the individual patient has been ignored by most cardiac surgeons. Historically, adequate exposure of the target tissues or organs through large skin incisions took priority over concern about incision size; this mindset remained unchallenged until the early 1990s. Subsequently, with novel specially designed instruments, experience with laparoscopic surgery demonstrated that those surgical procedures traditionally performed through large incisions could actually be accomplished with much smaller incisions. The patient benefits of small inci sions have been clearly shown; advantages include less pain, quicker recovery, lower infection rate, shorter hospital stays, and better quality of life (1,2). In some studies, less immune function disturbance has also been reported (3).

Encouraged by positive results from the laparoscopic surgical community, some cardiac surgeons began to modify their approaches to perform less-invasive cardiac surgery. Currently, a variety of approaches have been attempted: (1) tho-racoscopies or minithoracotomies to replace thoracotomies and (2) partial sternotomies, partial thoracotomies, or mini-thoracotomies to replace full sternotomies. Nevertheless, car-diopulmonary bypass support, if required, is established through cannulation in the peripheral vessels such as the femoral arteries, femoral veins, and internal jugular veins. Various studies have reported advantages with smaller incisions or sternum-sparing incisions in terms of pain, time to recovery, infection, and cosmesis (4,5).

However, it must also be considered that smaller incisions have certain drawbacks. To have the same access and visualization as with larger incisions, special instruments and specialized surgical skills are required, and only selected patients are eligible. For surgeons, the initial learning curve to be able to perform such procedures clinically can be very steep. Nevertheless, smaller incisions are certainly very appealing to both patients and referring physicians. To date, more and more surgeons are moving toward smaller incisions and the use of these specialized less-invasive surgical methodologies, even though the conversion process is often considered painfully slow.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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