Minimally Invasive Bentall Procedure via Right Lateral Transaxillary Access

As a part of the “One-Access Concept,” the median sternotomy is the main surgical access route for all cardiac surgical procedures. As a way to translate this concept into minimally invasive cardiac surgery as a counterpart to the full median sternotomy, the authors have established the right lateral transaxillary (RLT) thoracotomy in their institution. Via this access route, following the One-Access Concept, routine surgical treatment of the aortic, mitral, and tricuspid valves, as well as their combination, and removal of left or right atrial masses such as myxomas is possible (1, 2, 3). The origin and further development of the RLT approach is inspired by the “Miami Method,” originally developed by Dr. Joseph Lamelas (4). 

Based on this information, this video demonstrates a minimally invasive Bentall procedure via right lateral transaxillary access. For the thoracotomy, an incision of 5 cm was made along the right anterior axillary line to gain access to the third intercostal space without dissection of any ribs. The aorta could be easily reached using a soft tissue retractor and gentle rib spreading. Cardiopulmonary bypass was established by femoral cannulation.

References

1. Wilbring M, Arzt S, Alexiou K, Matschke K, Kappert U. Surgery without visible scars-double valve surgery using the right lateral access. Ann Cardiothorac Surg. 2020 Sep;9(5):424-426. doi: 10.21037/acs.2020.03.16. PMID: 33102183; PMCID: PMC7548216.
2. Wilbring M, Matschke KE, Alexiou K, Di Eusanio M, Kappert U. Surgery without Scars: Right Lateral Access for Minimally Invasive Aortic Valve Replacement. Thorac Cardiovasc Surg. 2020 Oct 19. doi: 10.1055/s-0040-1713137. PMID: 33075824.
3. https://www.ctsnet.org/article/surgery-without-visible-scars-right-later...
4. Lamelas, J., Minimally invasive aortic valve replacement: the "Miami Method". Ann Cardiothorac Surg, 2015. 4(1): p. 71-7.

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