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53-year-old undergoes India’s first keyhole multiple bypass

Dr Naresh Trehan conducted India’s first keyhole multiple bypass surgery on Suman Singhal (53) at the Indraprastha Apollo hospital last week.

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Dr Naresh Trehan conducted India’s first keyhole multiple bypass surgery on Suman Singhal (53) at the Indraprastha Apollo hospital last week.

It took him less than four hours to perform the scarless surgery, without cutting any bone of the patient.

Conventionally, the breastbone is cut to reach the heart.

Singhal, from Uttar Pradesh, was diagnosed with multiple blockages.

Trehan and team put five grafts in her blood vessels through a three-inch incision, using the minimally invasive coronary artery bypass grafting method and octopus stabilisers. The stabilisers are reusable tissue stabilisers with collapsible pods that enable insertion into and removal from the thoracic cavity through a port, eliminating the need for an incision for the stabiliser’s insertion.

“It is the first of its kind surgery. It will benefit patients, especially women. One cannot see the scar as it is below the breast,” said Dr Trehan, senior cardiovascular and thoracic surgeon at Apollo.

The technique uses a combination of small holes in the chest and a small incision, made indirectly over the coronary artery to be bypassed. It is often performed using robotics and video-imaging, which help the surgeon operate in a small area. 

In Suman’s case, three incisions were made: two to insert equipment that stabilised the heart; from the third, the surgeon manually performed the bypass.

“In conventional bypass, the sternum (chest or breastbone) is cut open, which takes at least eight weeks to heal. This is the first time in India multiple grafts have been put, especially at the back of the heart, through minimally invasive coronary surgery,” said Dr Trehan.

“Two instruments stabilise the heart. The octopus stabiliser is inserted from the right and has a suction pump attached. The instrument sucks the heart and stabilises it. The other instrument, inserted from the left, helps stabilise the heart. An 8-cm incision is made underneath the breast, through which we put grafts taken from the internal mammary artery and radial artery. Accessing the backside of the heart is difficult through minimally invasive surgery. Even in robotic surgery, we cannot put grafts at the back of the heart, but we are developing it. Here, the instrument that holds the heart can rotate it so that the backside is clearly visible to the surgeon,” Dr Trehan explained.


 

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