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The question: I recently had a minimally-invasive heart-bypass operation. I expected there would be a lot less pain with minimally-invasive surgery because the incisions are much smaller than the regular operation. So I wasn’t prepared for the amount of pain I felt in the first few days after the surgery. The doctor did a wonderful job – don’t get me wrong. Still, I’d like to know: Was I mistaken to think that a minimally invasive bypass wouldn’t be very painful?
The answer: You are not the only patient to have assumed that a minimally-invasive operation would be minimally painful. Maybe the name of the procedure itself creates that impression. But it’s still a major operation and it’s going to hurt some.
Putting aside the issue of pain for a moment, let’s compare the two procedures.
The main purpose of a bypass operation is to improve blood flow to the heart tissue, says Dr. Fuad Moussa, a cardiac surgeon at Sunnybrook Health Sciences Centre.
A piece of blood vessel harvested from other part of body is stitched onto the surface of the heart to create a bypass – or detour – around an existing coronary artery that has become blocked or narrowed with plaque deposits. Some patients may need multiple bypasses.
For a traditional bypass, a battery-powered saw is used to cut through the breastbone and expose the heart. “It’s a very controlled entry. We don’t crack open the chest,” explains Dr. Moussa. The incision, running up the middle of the chest, can be up to 10 inches long.
The patient is connected to a heart-lung machine that takes over the job of oxygenating the blood and pumping it throughout the body. The heart is stopped, permitting the surgeon to attach the bypass graphs while the organ is still. Once this work is completed, the heart is restarted, and the chest is closed with stainless steel wires.
By contrast, a minimally-invasive procedure involves a relatively small three-to five-inch incision made between two ribs on the left side of the chest. The ribs are pried slightly apart to gain access to the heart. Another small cut is made to insert an instrument that steadies the portion of the heart where the surgeon is stitching. The patient’s heart continues to beat throughout the operation, and there is no need of the heart-lung machine.
Minimally-invasive surgery isn’t for everyone. The blocked arteries must be in spot that can be reached through the ribs. But for those who qualify, this procedure has a number of benefits over the conventional operation.
Recovery tends to be faster. Patients return home within three-to-five days, rather than the usual five-to-seven days. “We get you out of the hospital sooner, and we will get you back to your regular activities earlier,” says Dr. Moussa.
There is also less chance of serious infection because the incisions are relatively small and the breastbone is not severed. What’s more, patients are spared the potential risks associated with the heart-lung machine. The equipment can damage blood vessels and increase the chance of clots that may cause a stroke or lead to other problems.
“There are multiple advantages of minimally invasive bypass surgery – none of which is pain-free,” says Dr. Moussa.
“I have noticed that younger patients have less tolerance to pain than older patients.”
As well, relatively robust individuals with a lot of muscle tend to be particularly sensitive to the pain from minimally-invasive bypass surgery. In these patients, the ribs may need to be separated further apart than usual in order to adequately expose the area of surgery. “We try to gain more space by pulling harder on the retractors and that might be the reason some patients experience more post -surgical pain than others,” says Dr. Moussa.
Even for these patients, the pain tends to be short-lived, and they can expect a relatively speedy recovery.
Pain, of course, is a very personal thing. You are the best judge of your own pain tolerance. If you feel your post-surgical pain is not under proper control, don’t suffer in silence.
“The patient should bring it up with the [medical] team,” advises Dr. Moussa. He says medications can be adjusted to make the patient more comfortable.
Paul Taylor is Sunnybrook’s Patient Navigation Advisor. His column Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca