BACKGROUND: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period. METHODS: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective database and analyzed retrospectively. RESULTS: Data from 151 patients were assessed (mean age, 63.4 ± 9.7 years; 55% were females). Overall 30-day mortality was 0.7% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 254.9 ± 48.7, 140.5 ± 36.1, and 94.8 ± 27.0 minutes, respectively. Associated procedures were tricuspid valve annuloplasty (37.1%, n = 56) and closure of atrial septal defect (6.0%, n = 9). Cryoablation was performed in 43.7% of patients (n = 66). One patient (0.7%) required conversion to median sternotomy and six patients (4.0%) underwent re-explorations due to bleeding. Median postoperative hospital stay was 12 days. Overall survival at 5 years was 94.1% ± 2.0%. Freedom from reoperation was 94.6% ± 2.9% at 5 years. CONCLUSIONS: MIMVS is a feasible, safe, and reproducible approach with low mortality and morbidity. Mitral valve surgery through a small thoracotomy is a good alternative to conventional surgical access.

• Klíčová slova
• endoscopic surgery, minimally invasive, minithoracotomy, mitral valve, mitral valve repair,
• MeSH
• anuloplastika mitrální chlopně * škodlivé účinky   mortalita   MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně * škodlivé účinky   mortalita   MeSH
• databáze faktografické MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• mitrální insuficience diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• torakotomie škodlivé účinky   metody   mortalita   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

The authors present the case of successfully treated patient with CAD, operated from left anterolateral minithoracotomy. Angiographic control two years later presents fully patent anastomosis without any signs of stenosis.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• revaskularizace myokardu metody   MeSH
• torakotomie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

• MeSH
• defekty septa síní chirurgie   MeSH
• dospělí MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony * MeSH
• mladiství MeSH
• torakotomie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: Introduction of the new method of videoassisted multiple direct revascularization of the heart muscle from left-sided minithoracotomy (LAST--Left Anterior Small Thoracotomy) using an automatic connector of central anastomoses Symmetry (St. Jude Medical ATG, Inc., St. Paul, MN) in patients indicated for re-operation of bypasses of the coronary arteries or with pathological conditions of the sternum and for the cosmetic effect of submammary incisions in women. METHOD: From September 2001 to the end of February 2002 15 patients with affections of three arteries had an operation from a LAST approach with videoscopic construction of central anastomoses by means of a Symmetry connector with portal entries and the use of extracorporeal circulation introduced from the groin without cardioplegic arrest. Nine men and six women were operated with a mean age of 68.7 years and a mean ejection fraction (EF) of 58.2%. In seven instances reoperation of aortocoronary bypasses was involved; two patients with multiple myelomas (morbus Kahler) had a brittle and cavernously altered sternum, all six women wanted a small skin incision below the breast. The criterion for ruling out the mentioned procedure was marked atherosclerotic affection of the ascendent aorta, affection of the arteries in the aortoiliac area and affection of one or two coronary arteries suitable for miniinvasive revascularization without extracorporeal circulation. Fourteen patients had an angiographic check up examination of the patency of grafts before they were discharged. RESULTS: The total number of distal anastomoses per patient was 3.13 +/- 0.6, the median period of extracorporeal circulation was 112 +/- 34 minutes and the mean time of operation 186 +/- 52 minutes. Blood losses were on average 425 ml/24 h without necessity of revision on account of haemorrhage. Eleven (73%) patients were subjected to an ultra fast track protocol with extubation on the operating table. The mean time spent in the postoperative department was 8.6 hours and the total hospitalization period 5.5 days. None of the operated patients died. Peroperative ischaemia of the heart muscle was not observed, in one instance the authors observed a newly developed atrial fibrillation. During an angiographic check-up the authors detected 6 (13.6%) stenoses and occlusions in 44 checked bridged vessels. CONCLUSION: The alternative approach reduces the risk of cardiac injury during reoperation and the danger of impaired healing of the sternotomical wound in patients with pathological conditions of the sternum, with contamination of the surrounding tissue (e.g. in tracheostomy) or malignant disease. The cosmetic effect of the submammary incision, the small inguinal incision and endoscopic saphenous vein harvesting should be considered in elective direct revascularization of the heart muscle in women. Bridging of the coronary arteries with optical assistance from minithoracotomy and with an automatic connector of central anastomoses seems to be a safe alternative of standard sternotomy only with methodological but not anatomical or functional restriction.

• MeSH
• anastomóza chirurgická přístrojové vybavení   MeSH
• chirurgické nástroje * MeSH
• hojení ran MeSH
• hrudní chirurgie video-asistovaná * MeSH
• koronární bypass přístrojové vybavení   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony přístrojové vybavení   MeSH
• reoperace MeSH
• senioři MeSH
• torakotomie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

OBJECTIVES: Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. METHODS: A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. RESULTS: Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). CONCLUSIONS: In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.

• Klíčová slova
• Endoscopic surgery, Minimally invasive, Minithoracotomy, Mitral valve,
• MeSH
• kardiochirurgické výkony * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony * metody   MeSH
• mitrální chlopeň chirurgie   MeSH
• nemoci srdečních chlopní chirurgie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• sternotomie * metody   MeSH
• tendenční skóre MeSH
• torakotomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. METHODS: Between 2002 and 2014, a total of 176 patients were treated by this technique. The patients received either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. RESULTS: In the anterior procedure, the average operative time was 90 min. (50 to 130 min). Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at two years follow-up. CONCLUSION: The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.

• Klíčová slova
• thoracolumbar junction; minimally invasive approach; transdiaphragmatic approach; thoracoscopy,
• MeSH
• bederní obratle zranění   MeSH
• dospělí MeSH
• fraktury páteře chirurgie   MeSH
• fúze páteře metody   MeSH
• hrudní obratle zranění   MeSH
• krvácení při operaci MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• torakoskopie metody   MeSH
• torakotomie metody   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Minimally invasive surgical access for the treatment of mitral and tricuspid valves has become an alternative method to the conventional approach via median sternotomy. The aim of this paper is to evaluate our experience and results with minimally invasive approach in cardiac surgery at our institution. MATERIAL AND METHODS: A total of 52 patients underwent minimally invasive cardiac surgery between November 2011 and March 2013. Right lateral minithoracotomy and femoral vessels cannulation for cardiopulmonary bypass was used. Follow-up data was collected in a prospective database and analysed retrospectively. RESULTS: The mean age of patients was 60.9 ± 11.6 years (female patients accounted for 63.5%). The procedures performed included mitral valve repair in 44 (85%) patients and tricuspid valve repair in 25 (48%). Atrial septal defect closure was performed in 8 (15%) patients and cryoablation of atrial fibrillation in 26 (50%) patients. There were 75% combined procedures. The median duration of the operation was 235 (155-315) minutes. The median length of cardiopulmonary bypass and crossclamp time was 139 (89-225) and 92 (51-168) minutes, respectively. The median duration of postoperative hospital stay was 12.5 (6-34) days. Hospital and 30-day mortality was 0%. At follow-up (121.3 ± 32.72 days), two patients (3.8%) required reoperation (1 for right haemothorax, 1 for aortic valve insufficiency). CONCLUSION: Minimally invasive access has been adopted as a routine method for the therapy of valve disease. The minithoracotomy approach is a safe and feasible technique with comparable mortality and in-hospital morbidity.

• MeSH
• aortální insuficience chirurgie   MeSH
• chirurgie s pomocí počítače metody   MeSH
• kardiochirurgické výkony škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• nemoci srdečních chlopní chirurgie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The authors present their first experience and the results of robot-assisted pulmonary lobectomies. The paper reports on the placement of the working channels, auxiliary minithoracotomies, the patient's position, the positions of the four-arm body of the da Vinci robotic system, and particularly the technique of lobectomy. In our institution, 4 robot-assisted lobectomies were performed in two women and two men (aged 45, 52, and 57, 67 years, respectively). The vessels were ligated mechanically with the use of the robot. An auxiliary minithoracotomy of a length of 5 cm was performed in the fifth intercostal area posterolaterally. The lower lobectomy was performed three times left and once right. The surgery was always supplemented with mediastinal lymphadenectomy. No serious complications were observed during the surgery or in the postoperative period. Robot-assisted lobectomy is a safe method of pulmonary resection in the early stages of bronchogenic carcinoma (Ia, Ib); it ensures a faster convalescence of the patient compared with open surgery (Ref. 14).

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie MeSH
• mediastinum MeSH
• nádory plic chirurgie   MeSH
• pneumektomie * MeSH
• robotika * MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The authors present the case of a 9-year-old boy who sustained a gunshot injury to the pericardium by an air gun. The penetrative wound to the pericardium was, according to the performed pre-operative diagnostic methods, initially believed to be a penetrative wound into the cardiophrenic angle of the left pleural cavity. The stabilized patient was indicated for an extraction of the projectile through a left anterior minithoracotomy, during which the projectile was found and successfully removed from the pericardium. The limits of pre-operative assessment, optimal treatment procedures, and surgical approaches in pediatric patients with gunshot injuries to the chest and heart are discussed.

• MeSH
• cizí tělesa * chirurgie   MeSH
• dítě MeSH
• lidé MeSH
• perikard diagnostické zobrazování   chirurgie   MeSH
• poranění hrudníku * chirurgie   MeSH
• střelné rány * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Primary cardiac tumours are rare. In 75% of cases, these are benign, mainly myxomas. The present case study describes a patient with an impressive epidemiological history, examined at a department of infectious diseases for progressing dyspnoea and subfebrile states. As part of differential diagnosis, the patient was sent for cardiological examination. Echocardiography unexpectedly revealed tumour of the left ventricle that explained patients symptomatology. The tumour was then quickly removed using right minithoracotomy and histology confirmed myxoma. The patient was, also due to the mini-invasive nature of the intervention, discharged from the hospital to home care on the 4th day of hospitalization with practically no complaints.

• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• dyspnoe etiologie   MeSH
• lidé MeSH
• myxom komplikace   diagnóza   MeSH
• nádory srdce komplikace   diagnóza   MeSH
• srdeční komory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH