Vietnam introduces endoscopic atrial septal defect repair technique to the world

Thursday, 2017-03-16 18:52:59
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An endoscopic atrial septal defect closure surgery carried out by medical staff at Hanoi’s General Hospital E. (Credit: NDO)
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NDO—For the first time, Vietnam has introduced the endoscopic atrial septal defect (ASD) repair techniques it developed to the world at a recent international thoracic and cardiovascular conference.

Among the 413 scientific papers presented at the UK’s Society for Cardiothoracic Surgery Annual Meeting 2017, the report “Totally Endoscopic without Robotic ASD Closure on the Beating Heart” by Dr. Le Ngoc Thanh has been highly appraised by international colleagues and practitioners in the field.

Held in Belfast, the UK from March 12-14, the prestigious annual cardiovascular conference attracted over 1,000 physicians and scientists from all over the world.

At the meeting, Dr. Thanh, who is Director of General Hospital E and Head of the facility’s Cardiovascular and Thoracic Department, introduced his technique for repairing ASD through four trocar holes with a size of less than 1cm to foreign scientists. This is the first time the endoscopic technique has been brought to the international community.

The totally endoscopic ASD closure is a complex technique and at present even the UK has only several centres capable of performing endoscopic surgeries.

In his report, Dr. Thanh assessed that there are three main ways to treat ASD, including medical treatment combined with monitoring, occulting the vent via skin interventions and, finally, surgery. Nowadays, when the vent is not covered by skin intervention procedures, surgery is required to repair ASD.

According to him, previous ASD occlusion is always carried out with open surgeries, in which patients would have to have their entire breastbones cut with a long surgical path of about 15-20 cm. Patients usually suffer postoperative pain and possible complications, such as bleeding, sternal infection and bad scars that affect patients’ psychology after surgery. The length of hospitalisation and rehabilitation usually lasts from 15-20 days and especially patients are often at risk of chest deformation.

Therefore, advantages of totally endoscopic ASD closure are less likely to induce traumatic injury than open surgery, causing less postoperative pain and reducing the risk of wound infection.

Under the totally endoscopic beating heart surgical technique, a peripheral cardiopulmonary bypass is established via the femoral artery, the femoral veins and the right internal jugular vein. Surgical manipulations are performed via four trocar holes less than 1cm in size. The pleural and cardiac cavity is filled with CO2. ASDs are closed with patches, continuous suture on the beating heart and normothermia without aortic cross-clamping.

Dr. Thanh said that the technique was complex, but that Vietnam's successful implementation of it was a positive development and that in the coming time it could be widely applied and deployed to benefit many more patients, especially women and girls.

At present, General Hospital E’s Cardiovascular and Thoracic Department has performed the procedure for patients aged 30-40, as well as successful applying it on ASD child patients with large atrial interstitial vents, causing increased pressure on the pulmonary artery and heart failure.