Currently, the more successful MICS techniques include the following:
(1) Small-incision cardiac surgery: this type of incision can maintain the integrity of the thorax, with less bleeding, and the incision is more hidden for female patients, but there are considerable shortcomings, the main ones are: aortic cannulation is more difficult, and in case of an accident, the femoral artery needs to be cannulated immediately, and when performing an aortic valve surgery, the exposure of the operative field is poor, and the aortic valve surgery is not easy to perform, and the aortic valve surgery is not easy to perform. Poor exposure of the operative field during aortic valve surgery, compression of the right lung by surgical operation and one-lung ventilation have certain effects on lung function. The advantages of small incision cardiac surgery in terms of postoperative scar aesthetics are obvious, and small incisions can significantly reduce trauma, but it has been argued that, although the reduction in incision size may reduce some injury, the additional traction required for small incisions and the prolonged operative time due to poor visualization may increase the degree of trauma. Smaller incisions do not necessarily mean less trauma. It is extremely unwise to risk poor visualization of the surgical field in order to perform a low-quality cardiac surgery simply for the sake of the aesthetics of the surgical incision. Currently, small-incision surgery is mainly used for the correction of certain simple congenital heart disease, and small-incision valve surgery has also been carried out.
(2). Television-assisted thoracoscopic (VAST) cardiac surgery: VAST cardiac surgery provides good visualization and improves visualization compromised by the shortened length of the incision.The use of VAST minimizes the length of the incision. Compared to the lateral incision, the VAST cardiac incision is further reduced to 4-6 cm, which has been referred to as a window incision, a "keyhole" procedure. The successful performance of this procedure is based not only on the development of thoracoscopic techniques, but also on the development of an important extracorporeal circulation technique, the closed extracorporeal circulation technique. This is a catheterization system that establishes extracorporeal circulation through peripheral vessels (femoral artery and vein puncture cannulae) and allows for ascending aortic block, perfusion of cardiac arrest fluid, and intracardiac drainage.VAST was first used in cardiac surgery in the early 1990's, and over the past two decades, its advantages have gradually emerged, with significant advantages in terms of trauma, recovery, complications, and postoperative cosmetic outcomes, and it is now an important tool in the minimally invasive treatment of cardiac disease. Minimally invasive treatment of heart disease is one of the most important means. At present, it is mainly used in the following aspects: (1) arterial ductus arteriosus clamp closure; (2) atrial septal defect repair; (3) ventricular septal defect repair; (4) heart valve replacement; (5) coronary artery transplantation; (6) other. VAST cardiac surgery requires a certain amount of technical support, including not only instrumentation and equipment and the establishment of closed extracorporeal circulation routine support, but also the need for emergency treatment program in the event of an emergency, which is because of the existence of these problems, making it difficult to carry out this type of surgery, and at present, domestic units to carry out this type of surgery is still very limited. Some people believe that the right side of the chest wall three-hole total thoracoscopic cardiac surgery method has been widely tried, the technology has been relatively mature, has been partially replaced by traditional surgery as a standard procedure, although the total thoracoscopic cardiac surgery has many advantages, but should also be seen for the cardiac surgeon, laparoscopic surgery is a completely new technology, the prerequisite is to be equipped with a good foundation of traditional cardiac surgery, the total thoracoscopic cardiac surgery has its own special requirements. Total thoracoscopic cardiac surgery has its own special requirements, and a long learning curve is its disadvantage. Combined with the allocation of domestic medical resources and the limited cardiac surgical base, the promotion of total thoracoscopic cardiac surgery has been somewhat restricted, but the advent of the era of true total thoracoscopy is unstoppable.