Endoscopic Techniques and Technology in Cardiac Surgery
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Purpose This article reviews the development of endoscopic technology in the field of cardiac surgery. It examines the basis for application of endoscopic visualization to previous open incision procedures; namely, the desire to decrease surgical morbidity and to improve patient outcome. Methods A literature review is conducted to provide a historical perspective of endoscopic saphenous vein graft harvesting as the initial cardiac surgical procedure utilizing an endoscope. Histological and immunohistochemical studies demonstrating acute efficacy are cited, as well as studies evaluating postoperative reduction in wound complications. Results The studies cited support the growth of the endoscopic technique and its adoption as the standard of care in coronary revascularization procedures. Subsequent expansion of the endoscopic approach to visualization and treatment of the epicardial surface in a closed chest technique is delineated. Demonstrated ability of a transparent tipped endoscope to visualize inside a beating heart suggests future applications for endocardial endoscopic therapy. Conclusions Successful visualization in a soft tissue, fluid or blood filled environment allowed the development of less invasive techniques in cardiac surgery, starting with graft procurement and extending to epicardial access. Continued research will allow development of endocardial endoscopic procedures to address internal cardiac structures as well.