Minimally invasive clearly means many different things to different people. Some people are obsessed by small incisions, to achieve surgical success then they may need much longer bypas times. Others are obsessed by off-pump surgery, in return they may need much larger incisions to achieve adequate re-vascularisation. Do we really understand the trade-offs? Is an on-pump strategy with a very low blood product useage actually worse than an off-pump strategy in a unit that doesn't cell save and therefore has a higher transfusion rate. (yes it is true, you can be on-pump and still have a very low blood product useage. You do have to CARE about your transfusion levels though!) I have been struck looking at photographs of lower hemi-sternotomy that you can achieve, with care, a full sternotomy through the same skin incision. It is difficult but you can do it. Do we all wear headlights? I find it very difficult to use a small incision without a headlight, the corollary could be no head light therefore big incision, could it not?
We have to remember that we do live in a competitive world, cardiologists and patients are pushing us down routes that we consider might not be in the best interests of the patient. Outcome, survival and long term quality of life must be our drivers. Where we do things well we must market. If we truly believe in what we do then we must take up the challenges to demonstrate that what we do, be it, on or off pump, maximally or minimally invasive is of the highest currently attainable quality, but that we continue to strive to improve. If there are problems that we have not yet solved then we must solve them. At the end of the day we will have to transform our skills to meet the challenges as they arise, always realising that we must keep improving as cardiac suregry develops.
No comments:
Post a Comment