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How Surgeons Now Wear 3D Glasses for Heart Bypass Operations

More than 17,000 heart bypass operations are carried out each year. Before now doctors would have to cut into breastbone during a bypass, now, they can enter via a small incision and insert a camera into the artery. 3D technology allows them to see the heart as if looking with their own eyes.

 

This 3D technology has been used for two years in some gallbladder and prostate operations, but this is the first time it's been used for heart bypass surgery. © Getty Images

THE PATIENT

My health was always good. My father died of a heart attack at 72, but I didn't ever think I was at risk.

I kept myself fit with walking, going to the gym, cycling and gardening after early retirement ten years ago.

However throughout autumn last year I began to have an uncomfortable feeling in my chest when exercising.

It felt like indigestion, but after a few months I visited my GP, who said it should be investigated.

Ten days later I had an electrocardiogram (ECG) at the surgery, to record the electrical activity of my heart.

t didn't show any problems, but given what had happened to my father the GP sent me for other tests at my local hospital's chest pain clinic.

There, I was given an angiogram — an X-ray of my heart's blood vessels — which showed one of my arteries was 96 per cent blocked on my left side, reducing blood flow to my heart.

The doctors said I could have a heart attack at any time and I was showing early signs of heart failure.

Because my other arteries weren't blocked I was told the problem must be genetic.

My wife Jacqueline and I were in total shock — we just sat silently holding on to each other.

The doctors said I would need a procedure to restore the blood flow to my heart, and the following day I met Ranjit Deshpande, a specialist heart surgeon from King's College Hospital who was visiting the hospital.

He said he would carry out a keyhole heart bypass operation at King's — where they would use an artery from my chest to reroute the blood around the blockage.

To say I was apprehensive was an understatement, but it was my only option.

I had the two-hour operation in February. It was only when I woke up that I discovered they had used new 3D technology.

The surgeon had used a special camera that allowed him to see my blocked artery in 3D on a screen. They even wore 3D glasses.

It meant they could see my entire heart and the affected artery more clearly than with a standard keyhole operation.

That meant they could be more accurate about where they were placing the new artery.

It apparently makes the whole thing easier and quicker for the surgeons, which meant a faster recovery for me.

I was the first to have it done in this country, which was a good feeling.

Four days later I left hospital, in little pain. After my operation, I was given ten different drugs, but now I'm on just four — including aspirin to thin my blood and a statin to reduce cholesterol.

I'm back to full fitness, with only the occasional bit of discomfort in my chest. I am thankful I visited my GP when I did.

THE SURGEON

Ranjit Deshpande is a consultant cardiothoracic surgeon at King's College Hospital NHS Foundation Trust.

Every year 74,000 people in the UK die from coronary artery disease.

This is where cholesterol and calcium deposits build up in the arteries until they become too narrow to take blood to the heart muscle.

When arteries are partially blocked, it can cause angina (chest pain), and when they are completely blocked it can cause a heart attack.

We can fit stents — tiny metal tubes — into arteries to keep the narrowed section open.

For more severe blockages, doctors will bypass the blocked artery using a blood vessel taken from the arm, leg or behind the breastbone — more than 17,000 such procedures are carried out each year in Britain.

It's effective but a very serious operation, which involves cutting through the breastbone.

This left patients in lots of pain, with a recovery period of up to six months. And some people were simply not fit enough for it.

So a few years ago, surgeons started doing the procedure using keyhole incisions in the chest.

We inserted a camera into one of these incisions so we could see the patient's heart on a screen while we operated.

It was a breakthrough, but had its downsides. When you see an organ in open-heart surgery it's obviously in 3D right in front of your eyes.

Having to adjust to seeing the patient's anatomy in 2D on screen made the operation more difficult.

We had to go slower because the limited vision meant there was a higher risk of cutting something in the wrong place.

It took up to six hours instead of the four hours with open surgery.

But new 3D camera technology allows us to see the heart exactly as we would with the naked eye — but without those extra risks, pain and long recovery that come with cutting the breastbone.

We insert a tube called a thorascope into the patient's chest — on the end are two cameras at right angles to each other, which superimpose one image on top of another.

This 3D image is transmitted to a screen in the operating theatre and we all wear 3D glasses to see it properly.

These are sophisticated versions of the ones you wear to see 3D movies. It almost feels as if you can reach out and touch the heart.

By tilting the thorascope we can rotate the image to get a better understanding of the anatomy we're operating on, and can see it from all angles.

This technology cuts the operation time by at least half. The patient recovers more quickly (two weeks compared with six to eight weeks with standard 2D keyhole).

It's a game changer. Called endoscopy assisted coronary artery bypass surgery, we are using it on patients requiring one or two bypass grafts.

As experience grows it will be used for triple or quadruple bypass grafts as well.

First, with the patient under general anaesthetic, we use a special breathing tube to isolate their left lung.

We then deflate the lung so we can access the left side of the chest.

Next we insert the thorascope via a 5mm incision in a space between two ribs.

We then make two more incisions nearby for forceps and a cutting device.

After another incision, we cut the end of the left internal mammary artery (LIMA: a branch of the artery which takes blood to the left hand, and the artery typically used in single bypass surgery) and join it to the blocked artery, bypassing the narrowed area.

Afterwards, we re-inflate the lung and close the incisions.

This 3D technology has been used for two years in some gallbladder and prostate operations, but this is the first time it's been used for heart bypass surgery.

The 3D technology also means it is easier to train surgeons which will help make these minimally invasive types of operations more widely available.

In future, we will extend its use to different heart operations (such as heart valve repairs and holes in the heart) and for other organs, too.

What are the risks?

The procedure carries a minor risk (less than 1 per cent) of stroke, heart, kidney or lung failure that could lead to death.

There is a similarly small risk of excessive bleeding.

'Surgeons have to be careful to be accurate when operating on the left coronary artery, the heart's most vital artery,' says John Pepper, a consultant cardiac surgeon at Royal Brompton Hospital, London.

'If attached correctly the bypass can remain in place for 20 years.

'If not it can lead to problems, including heart attack. 3D camera technology makes it easier to be accurate, and does not pose any additional risks.'

The procedure costs the NHS £9,000. Privately it costs £15,000.

 

Source: Mail Online

 

 

How Surgeons Now Wear 3D Glasses for Heart Bypass Operations

 
 
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The Operating Theatre Journal, OTJ, is published monthly and distributed to every hospital operating theatre department in the UK. The distribution includes both the National Health Service and the Private Sector.

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